HomeMy WebLinkAbout51887-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#: 51887 Date: 04/30/2025
Permission is hereby granted to:
Barry Rokach
10775 Main Rd
East Marion, NY 11939
To:
legalize "as built" HVAC system as applied for.
Premises Located at:
10775 Route 25, East Marion, NY 11939
SCTM#31.4-18
Pursuant to application dated 03/25/2025 and approved by the Building Inspector.
To expire on 04/30/2027.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
ELECTRIC -Residential $200.00
CO-RESIDENTIAL $100.00
r Total $800.00
Eft iiding Inspector
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� TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Tele hone 631 765-1802 Fax 631 765-9502litt s:/l^s�rr w.sotitholdiowtt�� oar
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Date Received
APPLICATION FOR BUILDING PERMIT
E C E 0 V E
For Office Use Only
PERMIT NO. Building IrrSpectar: 01 2. 5
Applications and forms must be filled out in their entirety.Incomplete Bullding Department
applications will not be accepted. Where the Applicant is not the owner,an Town of Southold
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: -6 SCTM#1000- 3
_G
Project Address: -7 M<��l C( ,5
Phone#: Gt 11 q�7J Email:
Mailing Address: S
CONTACT PERSON:
Name: (6A
Mailing Address: M 4t,
Phone#:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ONO
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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? Eyes ENO 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): YJ 4( �1 DF� f t` ❑Authorized Agent ❑Owner
Signature of Applicant: ^ Date:
CONNIE D.BUNCH
` Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified in Suffolk County
COUNTY OF
Commission Expires April 14,
)
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
' day of ��—
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 FV 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
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APE'LICATION FOR ELECTRI AL INSPECT10N
ELECTRICIAN INFORMATION (All Information Required) Date: 3.01/2025
Company Name: Curtain Illuminations Inc.
Electrician's Name: Michael Curtin
License No.: ME-43839 Elec. email:Mikelites@msn.com
Elec. Phone No: 631-456-2548 El I request an email copy of Certificate of Compliance
Elec. Address.: 41 Breston Dr. West Shirley, NY 11967
JOB SITE INFORMATION (All Information Required)
Name: BARRY ROKACH
Address: 10775 MAIN ROAD EAST MARION NY 11939
Cross Street: Kaylei hs Ct. & Ketcham Ln.
Phone No.: 917-575-9646
Bldg.Permit#: email: brokach@gmail.com
Tax Map District: 1000 Section: Block: Lot: .01
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE`(Please Print Clearly):
Ran new 30 amp feed to ductless unit and wired unit with new whip and disconnect
uare Footage:,
Circle All That Apply:
Is job ready for inspection?: YES[]NO []Rough In Final
Do you need a Temp Certificate?: YES lr.l NO Issued On
Tamp Information: (All information required)
Service SizeLJ1 Ph�3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Unde round Laterals M 1 LL2 H Frame Pole Work done on Service? LJ Y N
Additional Information:
EA`II ME`NT DUE WITH APPLICATION
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