HomeMy WebLinkAbout51310-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#: 51310 Date: 10/23/2024
Permission is hereby granted to:
Stephanie V Seremetis
PO BOX 641
East Marion, NY 11939
To:
install generator as applied for.
Premises Located at:
3345 Private Rd #1, East Marion, NY 11939
SCTM# 22.-3-8.2
Pursuant to application dated 09/09/2024 and approved by the Building Inspector.
To expire on 10/23/2026.
Contractors:
Required Inspections:
Fees:
GENERATOR $125.00
ELECTRIC -Residential $100.00
CO Accessory $100.00
Total $325.00
!wilding Inspector
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06 TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
; ya Telephone (631) 765-1802 Fax (631) 765-9502 htt s://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
EC � 0 � �
For Office Use Only
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PERMIT NO. � Gv Building Inspector: y�ry�"n 02
Applications and forms must be filled out in their entirety. Incomplete BuIlding Deparfsnent
applications will not be accepted. Where the Applicant is not the owner,an Town! 0f outhcsId
Owner's Authorization form(Page 2)shall be completed.
Date: S (, 2oZ
OWNER(S)OF PROPERTY:
Name: S-(�>, SCTM # 1000- 2-?
Project Address: �Jy
Phone#: (� (�� _ Email. S e_ t h b C)r)D
Mailing Address: SGt
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
I,
Name;
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: ` I C'
Mailing Address:
Phone#: Email
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Tepair ❑DemoIitio Estimated Cost of Project:
❑Other t T � L G'f l�t� $ —2— 01Do
Will the lot be re-graded? ❑YesP%9 Will excess fill be removed from premises? ❑Yes MVo
1
PROPERTY INFORMATION
Existing use of property: l � Intended use of property:
es—
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
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 210.45 of the New York State Penal Law.
Application Submitted By(print name): ❑Authorized Agent ❑Owner
�-CE�� W�G- �-c-r�L=t✓i1 �
Signature of Applicant: Date: j 2� OZsf
STATE OF NEW YORK) CONNIE D.BUNCH
SS: Notary Public,State of New York
COUNTY OF No.01 BU61 86060
Qualified in Suffolk County �/
Commission Expires April 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 j�/n
Iday of , 200� M� " "
Notary Public
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
COFFO(K BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
T Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
iamesh southoldtownn gov - seand southoldtownn ov
APPLICATION FOR ELECTRICAL INSPECTION
C�
ELECTRICIAN INFORMATION (Ail Information Required) Date:
Company Name `
Electrician's Name:
License No.: Grzo Elec. email: e, l L
Elec. Phone No: ) D I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: S�
Address: (y rE (CDk ( S
Cross Street:
A L
Phone No.: - Z
Bldg.Permit#: email:
Tax Map District: 1000 Section: v Block: Lot: ,OC-)
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
G> er��ra+o
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES NO Rough In Final
Do you need a Temp Certificate?: YES F-] 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 2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
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NEW WOOD DECK TO -
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MATCH EXISTING.
I 75'-0' =
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41
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SITE PLAN
Scale: 1" = 50'-0"
CAMPBEI
3345 PRIVATI
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SEAL&SIGNATURE
SUMYRy
Scal 50'-0