HomeMy WebLinkAbout51271-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#: 51271 Date: 10/09/2024
Permission is hereby granted to:
Andrew Samaan
1210 Alberta Dr
Winter Park, FL 32789
To:
Legalize an "as built" HVAC system addition to an existing single-family dwelling as applied
for per manufacturers specifications.
Premises Located at:
600 Praity Ln, Cutchogue, NY 11935
SCTM# 109.-5-27.2 -
Pursuant to application dated 05/17/2024 and approved by the Building Inspector.
To expire on 10/09/2026.
Contractors:
Required Inspections:
ELECTRICAL- ROUGH, PLUMBING, ELECTRICAL- FINAL, FINAL,
Fees:
As Built HVAC $500.00
CO Single Family Dwelling-Addition /Alteration $100.00
ELECTRIC -Residential $200.00
Total S800.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
yN` Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt :Hwww. uLholdtowno . o
Date Received
APPLICATION FOR BUILDING PERMIT � � � h " � �''
r �
For Office Use Only
PERMIT NO, Building Inspector:
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant Is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: ,,; /5 1'2-q
OWNERS)OF PROPERTY:
Name: S1e.,,l A M SCTM #1000-
J I 5 I
Project Address: (D®� 4
Phone#: G 31 3 � Ern
Mailing Address: 6 0 O jog",i tie i 11 '
CONTACT PERSON:
Name: I t--k e" 11
k r7
Mailing Address: (, C)o I ( --
Phone#: �y 1a�') Emai : t'V1c4-c-rtcr VY► k" C 00 . cc
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
M
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
%Other ' ( v- C�ejJ ,) A 'C $
Will the lot be re-graded? ❑Yes)gNo Will excess fill be removed from premises? Dyes XNo
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
S/��
Zone or use district in which premises is situated: r7z7�0 Are there any covenants and restrictions with respect to
h4ocf 1006 k,410), /09.66 Q10tk '.Oo this property? ❑Yes)(No IF YES, PROVIDE A COPY.
❑ 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 210AS of the New York State Penal Law.
Application Submitted B (print name): Ofx-T72,1(-)A 1�4 XA7/ 7rizA ent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTYOF
VoAr iC is kopf M ty) being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(Contractop Agent,, Corporate Officer, etc.)
of said owner or owners, and is duly authorized to 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
day ofMaw 20i$ �Arjjroj r,*e ?)jjj)P
Notary Public
TIAA EY L. D YER
NOTARY PUBLIC,STATE OF NEW YoRI ,
PROPERTY OWNER AUTHORIZATION IEDINSUFFOL C
Ql.)ALIFIED HV SUFFOLK COUN
(Where the applicant is not the owner) COMOSSION EXPIRES JUNE 30,2,0&
1 A, P A residing at hAA14 � � Z G/ �
do hereby authorize �' to apply on
9
my b al Taman of Southold Building De p ent for approval as described h7;i n.
� �
F Owner's 5 g ul=e Nj- Date
AlU l s__g/1 4 AC0l M AJ
Print Owner's Name
2
a on w "h
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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
arnesh southoldtownn ov- seared southoldtownn , ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: X 15 J Zy
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: a ,� p r,l
Address: AN 1193
Cross Street:
Phone No.: toll -�
Bldg.Permit#: G I W7 ( email c,f, p 9- �oo.Go rH
Tax Map District: 1000 Section: /0 /': D o Block: Of. D iD Lot: D , oa 2
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Foota e:
Circle All That Apply:
Is job ready for inspection?: YES ' NO Rough In 1-1 Final
Do you need a Temp Certificate?: YES ® NO Issued On
Temp Information: (All information required)
Service SizeF-11 Ph 3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 0 1 n2 R H Frame Pole Work done on Service? 11 Y N
Additional Information:
PAYMENT DUE WITH APPLICATION