HomeMy WebLinkAbout50983-Z �. TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Ia TOWN CLERK'S OFFICE
w SOUTHOLD, NY
" BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit #: 50983 Date: 7/25/2024
Permission is hereby granted to:
Emorv, Tremaine
76 Lai ht St, Apt#3
New York, NY 10013
To: Legalize "as built" mini-split HVAC unit to an existing single-family dwelling as applied
for per manufacturers specification.
At premises located at:
1200 Indian Neck Ln, Peconic
SCTM # 473889
Sec/Block/Lot# 86.4-3
Pursuant to application dated 6/5/2024 and approved by the Building Inspector,
To expire on 1/24/2026.
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $500.00
CERTIFICATE OF OCCUPANCY $100.00
ELECTRIC $200.00
Total: $800.00
Building Inspector
Fat
�V11 TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax (631) 765-9502 litips,//www.southoidtowiiiiy.,,00v
ow
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. 5 0� � Building Inspector:—� U - 5 2024
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an aryl r*rn.�rtt
Owner's Authorization form(Page 2)shall be completed. '.')wn of SouU,, !d
Date:MAY 30, 2024
OWNER(S)OF PROPERTY:
Name:TREMAINE EMORY & ANDEE MCCONNE SCTM#1000-
Project Address:1200 INDIAN NECK LANE, PECONIC NY 11958
Phone#:917- 310-8522 Email:ANDEEKM@GMAIL.COM
MailingAddress:76 LAIGHT ST., NEW YORK, NY 10013
CONTACT PERSON:
Name:ANDEE MCCONNELL
Mailing Address:76 LAIGHT ST., NEW YORK, NY 10013
Phone#:917-310-8522 Email:ANDEEKM@GMAIL.COM
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
00therPERMIT FILE FOR A SPLIT UNIT ALREADY INSTALLED B $N/A
Will the lot be re-graded? ❑Yes NNo Will excess fill be removed from premises? ❑Yes ■No
1
PROPERTY INFORMATION
Existing use of property:RESIDENTIAL Intended use of property:RESIDENTIAL/ RENTAL
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
PECONIC (SUFFOLK COUNTY) this property? ❑Yes ■No IF YES, PROVIDE A COPY.
IN Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and in building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name):ANDEE MCCONNELL []Authorized Agent ■Owner
Signature of Applicant: Date: MAY 30 2024
' O�IED. UNCH
Notary Pub('io,State of New York
STATE OF NEW YORK) No,01BU6185050
SS: Qualified in Suffolk County
COUNTY OF ) commission ExpiresA,pril 14,2 ,
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(Contractor,Agent,Corporate Officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this
application;that all statements contained in this application are true to the best of his/her knowledge and belief;and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this-t ay of I �- 20� E�� -L /�& c/�
Notary Public
(Where the applicant is not the owner)
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
V0ff1 BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
w Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
'arnesh @ southoldto!wnn . ov - seand-cZDsoutholdtownnygcv
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: Tremaine Emory & Andee McConnell
Address: 1200 Indian Neck Lane, Peconic NY 11958
Cross Street:
Phone No.: 917-310-8522
Bldg.Permit#: 5p email:andeekm@gmail.com
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
APPLYING FOR A PERMIT FOR A SPLIT AIR UNIT THAT HAS BEEN INSTALLED ALREADY 8
Square Footage:
Circle All That Apply:
Is job ready for inspection?: P11YES NO F-�Rough In Final
Do you need a Temp Certificate?: 1:1 YES NO Issued On
Temp Information: (All information required)
Service Size1:11 Ph 3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 2 H Frame LJ Pole Work done on Service? FJ Y IN
Additional Information:
PAYMEU NT D E WITH APPLICATION