HomeMy WebLinkAbout51817-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#: 51817 Date: 04/08/2025
Permission is hereby granted to:
2245 MCR LLC
c/o Marcello Pica Mng Mbr
Centereach, NY 11720
To:
construct alterations to existing commercial space (Dunkin Donuts) as applied for.
Premises Located at:
620 Traveler St, Southold, NY 11971
SCTM#61.4-13.1
Pursuant to application dated 02/28/2025 and approved by the Building Inspector..
To expire on 04/08/2027.
Contractors:
Required Inspections:
DRAINAGE, FOOTING/REBAR, FOUNDATION 1ST, FOUNDATION 2ND, FRAMING/STRAPPING , PLUMBING ,
ELECTRICAL- ROUGH, FIRE RESISTANT PENETRATION , ELECTRICAL- FINAL, INSULATION , FIRE SAFETY
INSPECTION , FIRE RESISTANT CONSTRUCTION , FINAL,
Fees:
Commercial-Alteration $426.50
CO Commercial $100.00
Total $526.50
—(/1,
k1ding Inspector
der � 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 htt s:Hwww.s���
Date Received
APPLICATION FOR BUILDING PERMIT
4
/j For Office Use Only
�l �I g A d:1 f-1 r���25
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: Z/ T. Z�S
OWNERS)OF PROPERTY:
Name: -D U SCTM#1000-
Project Address: 5 S �,�- o� S Sp ��� 1 c, �,� N 7 1
Phone#: ��� -7(O� �3 3 C) I Email: C" V 0- r
Mailing Address: S f o2-o MG�VI l2c� o v,41-0 /I �1
CONTACT PERSON:
Name:
Mailing Address: ���� �� wa lb
Phone#: b� c r ,� Email: CYYI�Y'E -00 S ��
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR.INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑ ew Structure ❑Addition. ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
JOther 6=�T)'rz $
Will the lot be re-graded? ❑Yes El No A Will excess fill be removed from premises? ❑Yes EA1qo
1
PROPERTY INFORMATION
Existing use of property: Intended use of property: S"V
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.
0
Application Submitted By(print name):P64V1,C4 C\ ( r ao re- Authorized Agent ❑Owner
Signature of Applicants � , Date:
OONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01BU6185050
SS: (qualified in Suffolk County
COUNTY OF ) 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
(Contrasµ Voperform
Agent,Corporate Officer,etc.)
zedof said owner or owners, and is duly authori 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
�,Q�ky of 20_6 S�5
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
residing at
do hereby authorize Gt / o/�dhC— to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
OwneA Signature U bate
Print Own r' Name
2
w
� f 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
, y a,mesh soufholdtownn . ov - seand@southoldtownn,y.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: L
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an,6mail copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name:
Address: 5:35 y S' 04A 2,Sr-
Cross Street:
Phone No.: &
Bldg.Permit#: email:
Tax Map District: 1000 Section: Block: Lot: I
INCLUDE S FOOTAG (Please Print Clearly):
BRIEF DESCRIPTION OF WORK, INCL SQUARE O
S uare Foota e:
Circle All That Apply: m
Ccd
Is job ready for inspection?: l / � YES NO []Rough In Final
a Certificate?: - YES NO
Do you need Temp � Issued On
Temp Information: (All information required)
Service Size�1 Ph�3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 H Frame Pole Work done on Service? L I Y nN
Additional Information.
PAYMENT DUE WITH APPLICATION