HomeMy WebLinkAbout51717-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#: 51717 Date: 03/06/2025
Permission is hereby granted to:
Christopher R Doman
154 W 70th St Unit 3111
New York, NY 10023
To:
legalize "as built"additions and alterations to existing single-family dwelling as applied for. Additional
certification may be required.
Premises Located at:
110 Sleepy Hollow Ln, Southold, NY 11971
SCTM#78.4-10.6
Pursuant to application dated 02/28/2024 and approved by the Building Inspector,
To expire on 03/06/2027.
Contractors:
Required Inspections:
Fees•
As Built Addition/Alteration $1,190.00
CO-RESIDENTIAL $100.00
Total $1,290.00
�� 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 litt ,.1/ .sotjtliol tgMgl y
Date Received
APPLICATION FOR BUILDING PERMIT
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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: 02�
OWNER(S)OF'PR PERW:
Name: t rl SCTM#1000-
Project Address: / 0 Jo 6
Phone#: Email:
Mailing Address: ., ,
CONTACT PERSON:
Name: ,
Mailing Address:
Phone#: ( ��� Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name.`: ... µ, �
e, I e
Mailing Address: l b S `� (� -
Phone#: "� 'I� Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Additiq ❑Alten ❑Repair ❑Demolition Estimated Cost of Project:
El other u f� �bG"`'� t
Will the lot be re-graded? Dyes El No 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 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.
Q
Application Submitted By(print name): � M + �*k ❑Authorized Agent ❑Owner
Signature of Applicant: �� Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01BU6185050
SS: Qualified In Suffolk County
COUNTY OF 1 ) Commisslon EXplresApril 14,2
L JQC' being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing c tract)a ve nam .d,
(S)he is the Cs
(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
day of 20_ �
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
Building DegarlLulLat Applation
AUTHORIZATION
(Where the Applicant is not the Owner)
�mc, residing at /to Jkv L-c Ni' ti 1-7/
(Print property owner's name) (Mailing Address)
do hereby authorize fil kz I i ej e
(Agent)
to apply on my behalf to the
Southold Building Department,
(Owner's Signature) (Date)
(Print Owner's Name)
BUILDING DEPARTMENT- Electrical Inspector
� ., TOWN OF SOUTHOLD
° Town Hall Annex- 54375 Main Road - PO Box 1179
H Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
amesh southoldtonn ov sea�nd southoldtownn ov
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APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 3 )u-.
Company Name: V 5 e-\.er—i/-1
Electrician's Name: L ek , uVS0'r-\
License No.: YYl (p r'1Z Elec. email: k- �i eJ r,' d (ostf�41C .Ccr'Y
Elec. Phone No: 1 y — 11S. ❑I request an email copy of Certificate of Compliance
Elec. Address.: $ o-�fU iel A -C- J le 11.
JOB SITE INFORMATION (All Information Required)
Name:
Address:
Cross Street:
Phone No.:
Bldg.Permit#: email:
Tax Map District: 1000 Section: Block: Lot: )'b.
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
P 6(-L1\ �Wro e fi J+-7
S uare Foota e:
Circle All That Apply:
Is job ready for inspection?: YES E] NO F—]Rough In Final
Do you need a Temp Certificate?: 11 YESJO NO Issued On
Temp Information: (All information required)
Service SizeEl1 Ph[—]3 Ph Size: A # Meters Old Meter#
❑New Service[]Fire Reconnect[—]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 M2 H Frame n Pole Work done on Service? Y RN
Additional Information:
PAYMENT DUE WITH APPLICATION
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eq
141
SU€-F"OLK COUNTY HE
SINGLE FAMILY DWELLING O LY
# OCT 7 -- t986 `
THE WAGE DISPOSAL AND WATER SUPPLY F (LITIE OR TH1
' . '
LOC ON HAVE BEEN INSPECTED BY THIS EPART NT AN
;� TO BE SATISFACTORY,
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