HomeMy WebLinkAbout51441-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#: 51441 Date: 12/05/2024
Permission is hereby granted to:
Patrick McElroy
140 Pine St
Garden City, NY 11530
To:
Legalize an "as built" HVAC/mini split system to an existing single-family dwelling as applied for.
Premises Located at:
440 Third St, New Suffolk, NY 11956
SCTM# 117.-9-20
Pursuant to application dated 10/11/2024 and approved by the Building Inspector.
To expire on 12/05/2026.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
CO Single Family Dwelling-Addition /Alteration $100.00
ELECTRIC -Residential $200.00
Total $800.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
i Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt s:Hwww,southoldtownn ov
Date Received
APPLICATION FOR BUILDING PERMIT
gz>2-2' �For Office Use Only
PERMIT NO. Building Inspector:_J OM
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: 2
OWNERS) F PROPERTY:
Name: c�L M (6- 1!
w SCTM#1000- -
Project Address: ( . -c
Phone#: C Email:
Mailing Address: - "
t R Qxc��,�t ; u
CONTACT PERSON:
Name:
Mailing Address: S'
Phone#: a.- Email;
lacewe. -6-� e t1a�
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:.
Phone#: 7mail-
DIESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Aditlon nAl teration ❑Repair ❑Demolition Estimated Cost of Project:
then
Will the lot be re-graded? ❑Yes o 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 ❑Yes ❑No IF YES, PROVIDE A COPY.
property?
❑ 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 buildings)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.
RNIV, �' CK M C
Application Submitted By(print name): []Authorized Agent ❑Owner
Signature of Applicant: CONNIE D.BUNCH Date:
Notary Public,State of New York
No.01 BU6185050
STATE OF NEW YORK) Qualified in Suffolk County
SS:
CoMMISSion Expires April 14,2 ag
COUNTY OF ) 1I
I
r C being duly sworn, deposes and says that (s)he is the applicant
(Name of i dividual s n'ng ntract) a 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
d�
11 ' day off , 20 r� b
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
� F Fat D-� BUILDING DEPARTMENT- Electrical Inspector
.. TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
r Telephone (631) 765-1802 - FAX (631) 765-9502
jamesh@southoldtownny.gov — sea nd southoldtownn . ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 2yf
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: c '
Address: L L Ad 11MQ
Cross Street:
Phone No.:
Bldg.Permit#: IH Lq email:
Tax Map District: 1000 Section: 117 Block: Cl Lot: D
jBRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES 0 NO Rough In Final
Do you need a Temp Certificate?: El YES 0 NO Issued On
Temp Information: (All information required)
Service SizeF-111 Ph[]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underg round❑Overhead
# Underground Laterals 1 R2 H Frame Pole Work done on Service? 11 Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
^
i � � � � f• r• r-•. 1 T .� � n T
..r .« w . -..r»...�ww....w«wn^ww�•-i..,.wr..r..,«..w..".._....a.: .i.n ... .. . . . ..w+www...•.w.....wVrwi.. ...-.- -......_ w.w .. J✓ ' l/�_`l 1�}��t .r a T.._
1 w .yr
• � �/ 5r�p it �� �► .
r
i} s-J,T r-1
DWAUT110RtUD ALTUA110M OR ADDITtOTT
JO 1H1S SUttYEY IS A VIOLATION Of
`` r7 ,;ECTION 7109 OF THL NEW YOLK STATE I 1� � � [ �� � / l f 1 �\•f r ` �k
,44 G�0 f Cds-z2��-� 1i21?/1/ CCZ ZB 3 20 F4ucAnor+ tAw. ! -` 1�• _.. .f i`- �� _ �ti i
COPIES OF THIS SU6YEY 1itAP NOT MAILING
FH[ LAND 3UAVOOP'S kl" Sih'L 01