HomeMy WebLinkAbout51060-Z JU
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
{� TOWN CLERK'S OFFICE
SOUTHOLD, NY
ar . BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLAINS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 51060 Date: 8/12/2024
Permission is hereby granted to:
Browne, Brendan
20 Glenside Rd
South Orange, NJ 07079
-------------
To: Legalize "as built" mini-split installation to a single-family dwelling as applied for per
manufacturers specifications.
At premises located at:
1400 Wunneweta d, Cutchog_ .....______
� ue _
SCTM # 473889
Sec/Block/Lot# 111.4-26.2
Pursuant to application dated 6/25/2024 and approved by the Building Inspector.
To expire on 6
p ................ ._ . m_
Fees:
AS BUILT- SINGLE FAMILY ADDITION/ALTERATION $500.00
CO-ADDITION TO DWELLING $100.00
ELECTRIC $200.00
Total: $800.00
Building Inspector
Fri 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 https: /www.soutlioldtownny.gov
Datp Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only r\
5 I 0 o ���N 5 2024PERMIT NO. Building Inspector:
Applications and forms must be filled out in their entirety. IncompleteWILDING DEF
g
applications will not be accepted. Where the Applicant is not the owner,an TOWN F,of m.f M'
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM# 1000-
Project Address: 1 4ob W uog,\w Q d, LTG ve
Phone#: S—) �7 d" y JEE n 116 .,1 .t ,
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: I=Email-
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑ itton ❑AltAd' " era 1io ❑Repair ❑Demolition $stimated Cost of Project:
Other
Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑No
1
PROPERTY INFORMATION
Existing use of property: intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ONO IF YES, PROVIDE A COPY.
❑I Check Brix After Reading: The owner/contractor/design professional is responsible for all drainage and stonm water issues as provided by
Chapter 236 of the Town Code. l PPUCATION 1S 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 taws,Ordinances or Regulotions,for the constr ctlan of buildings,
additions,alterations or for removal or dernotition as herein described.The applicant gees to comply with;all applicable lags,ordinances,bufldiraR tilde,
housing coda and regulations and to admit authorised fnspectors oil premises and in building(s)for netessary lnspections.False statements made herein are
puntstwi6le as a Class A misdemeanor pursuant to Section 210.4s of the News'York State Penal tasw�
Application Submitted By(print name): (�(-erg Can ' N VJVIC ❑Authorized Agent ❑Owner
Signature of Applicant: Date:
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified in Suffolk County
Commission Expires April 14,2MF(
COUNTY OF ).
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
�y of ,2D
Notary Public
PROPERTY OWNER AUTHORIZATION
(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
fftk BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
"amesh southoldtownn . ov — seand southoldtownn . ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑1 request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: AIA
Address: l °boa Vh tie )1, G( ,( . tZ `r
Cross Street: nJ do R
Phone No.: 5 1' 5 3(
Bldg.Permit #: S I y(v0 email: b�✓►�C <d�n
Tax Map District: 1000 Section: Block: Lot: ,
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
�<, �vrR M;fl; Y,0 M.,� 9-7mce
Square Footage:77
Circle All That Apply:
Is job ready for inspection?: YES NO Rough In Final
Do you need a Temp Certificate?: YES NO Issued On
Temp Information: (All information required)
Service Size1 Ph F-]3 Ph Size: A # Meters Old Meter#
❑New Service[:]Fire Reconnect[:]Flood Reconnect❑Service Reconnect[:]Underground❑Overhead
# Underground Laterals 1 H Frame 0 Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION