HomeMy WebLinkAbout51453-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH I ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 51453 Date: 12/06/2024
Permission is hereby granted to:
Brian Noll
45 Kilburn Rd
Garden City, NY 11530
To:
legalize "as built" mini split AC as applied for.
Premises Located at:
450 Maple Ln, Mattituck, NY 11952
SCTM# 107.-3-4.1
Pursuant to application dated 10/15/2024 and approved by the Building Inspector.
To expire on 12/06/2026.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
ELECTRIC -Residential $200.00
CO-RESIDENTIAL $100.00
Total $800.00
Building Inspector
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 his://,kvww.southoldttw nn u ,gy
Date Received
APPLICATION FOR BUILDING PERMIT (
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For Office Use Only a
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PERMIT NO. Building Inspector: 0 4
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:10.8.24
OWNER(S)OF PROPERTY:
Name:Barbara & Brian Noll
scTM#s000-107.-3-4.1
Project Address:450 Maple Lane Mattituck
Phone#:516-240-0106 516-850-0202 Email:bnoll@optonline.net
Mailing Address:.
CONTACT PERSON:
Name:Joan Chambers
Mailing Address:PO BOX 49 Southold NY 11971
Phone#:631-294-4241 Email:joanchambers10@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:LOu Schwartz
Mailing Address: 7 Ridgewood St, Bay Shore, NY 11706
Phone#: Email: runnereng@gmail.com
410-6838 tlderunneren mail.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
[--]Other-..AC added $
Will the lot be re-graded? ❑Yes W'No Will excess fill be removed from premises? ❑Yes RNo
i
PROPERTY INFORMATION
i
Existing use of property:Single family residence Intended use of property:same
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R_40 this property? ❑Yes li@No IF YES, PROVIDE A COPY.
W,,Check Box After Reading: The owner/contractor/design professional Is responsible for all drainage and stone 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 pass A misdemeanor pursuant to Section 210.4s of the New York State Penal Law.
Application Submitted By(print name):Joan Chambers NAuthorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
COUNTY OF — )
Joan Chambers being duly sworn, deposes and says that s heis the applicant
(Name of individual signing contract) above named,
(S)he is the
Agent
(Contract Agent, ' rporate Officer,etc.)
of said owner or owners,and is duly authorized to + corm o pr 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
5-F k
dayof—OCloh-CE 20� !1
otary Public
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
PROPERTY OWNER AUTHORIZATION NO.01DWs8oss00
QUALIFIED IN SUFFOLK COUNTY
(Where the applicant is not the owner) COMMISSION EXPIRES JUNE'E „
,,-Barbara residing at
Noll 45 Kilburn Road
�
Garden City, NY do hereby authorize Joan Chambers to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
f
Owner's Signature Date
/Jo
Print Owner's Name
2
I d 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
smash soutl oldto unn . 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: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: Barbara&Brian Noll (owners) Joan Chambers(agent)
Address: 450 Maple Lane Mattituck
Cross Street: Grand Ave.
Phone No.: Joan-631-294-4241 Barbara No11-516-850-0202
Bldg.Permit M b email:joanchambersl0@ gmail.com
Tax Map District: 1000 Section: 107 Block: 3 Lot: 4.1
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please PrintClearly):
Mini splits/AC installd without permit.
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES ONO [:]Rough In LJ Final
Do you need a Temp Certificate?: El YES 2] NO Issued On
Temp Information: (All information required)
Service SizeO1 Ph❑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? Ll
Y N
Additional Information:.
PAYMENT I UE WITH APPLICATION:
S.C.T.M.# DISTRICT 1000 SECTION 107 BLOCK 3 LOT 4.1
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S1eAM AT.MATTTnJCK CITIZENS BANK, N.A.;
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SUFfOLK COUNTY, NEW YORK Prot Tand d 41<74 9vARI.Y,
P.O. Box 153 Aquabogue, New York 11931 1 9/0MN
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