HomeMy WebLinkAbout51241-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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#: 51241 Date: 10/04/2024
Permission is hereby granted to:
Paul Mullins
1515 Plum Island Ln
Orient, NY 11957
To:
install generator as applied for.
Premises Located at:
1515 Plum Island Ln, Orient, NY 11957
SCTM# 15.-5-5
Pursuant to application dated 08/14/2024 and approved by the Building Inspector.
To expire on 10/05/2026.
Contractors:
Required Inspections:
Fees:
GENERATOR $125.00
ELECTRIC -Residential $100.00
CO Accessory $100.00
Total $325.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
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Telephone (631) 765-1802 Fax (631) 765-9502 https,:,/`/www.soutlioldtowDgygov
Date Received
APPLICATION FOR BUILDING PERMIT
D �(g[EOV[E D
For Office Use Only
PERMIT N0. a Building Inspector: AUG 120241
Applications and forms must be filled out in their entirety.Incomplete SUMMG
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed. TOWN 0FSi
Date:
OWNER(S)OF PROPERTY:
Name: �� �. +" , I-( (v SCTM# 1000-
Project Address: � � `�
L
Phone#: )T-� j r � Email: rnu� Cr)
Mailing Address: / [JL.( �,,
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name.
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: �N e c Jc ,
Mailing Address -7? L�.CK
Phone#: CO3( - 9 03- ) LI 3O Email:LG`0-L-,Rl. -F � 1`IUsK'I C�No7n'I1-7,
DESCRIPTION OF PROPOSED CONSTRUCTION
❑Other ~( A raair ❑Demolition Estimated Co st Project:
of
❑New Structure ❑Addition ❑Alteration ❑Re, � � $ �� ��
Will the lot be re-graded? Dyes ❑No Will excess fill be removed from premises? ❑Yes ONO
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.
El In howner/contractor/design rofessional is res onsible for all drains a and storm water issues as provided by
Box After Reading: P g CheckP
g
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.
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Application Submitted By(print name): w �,VLLIt4-5 ❑IALlthorize Agent ❑Owner
Signature of Applicant: Date: �
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01 BU6185050
SS: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14,24=�
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
da y of L4 1,4 , 20 NotaryPublic
r�
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
1, 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
II
S E P 3 �'024,
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLDRUIDING DEPT.
" Town Hall Annex- 54375 Main Road - a `10 `
El Southold, New York 11971 0959
10 �� Telephone (631) 765-1802 - FAX (631) 765-9502
arriesh southoldtownn oar— seand southoldtownn . ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 80/08/2024
Company Name: Modern Electric East, Inc.
Electrician's Name: T. Rutkowski
License No.: ME-4253 Elec. email: trut299@aol.com
Elec. Phone No: 516-903-7151 [D I request an email copy of Certificate of Compliance
Elec. Address.: PO Box 321, Mattituck, NY 11952
JOB SITE INFORMATION (All Information Required)
Name: Mullins
Address: 1515 Plum Island Lane, Orient, NY
Cross Street: UHL Lane
Phone No.:
Bldg.Permit#: "� email:
Tax (Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Installation of Standby Generator
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES ✓ NO Rough In Final
Do you need a Temp Certificate?: 1 YES 0 NO Issued On
Temp Information: (All information required)
Service Size01 Ph3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
#'Underground Laterals 1 2 H Frame11 Pole Work done on Service? DY N''
Additional Information:
PAYMENT DUE WITH APPLICATION
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