HomeMy WebLinkAbout51917-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#: 51917 Date: 05/14/2025
Permission is hereby granted to:
53245 Main Road Corp
10946 N Bayview Rd
Southold, NY 11971
To:
legalize "as built" HVAC system to existing building as applied for.
Premises Located at:
53245 Route 25, Southold, NY 11971
SCTM# 61.4-8.1
Pursuant to application dated 04/04/2025 and approved by the Building Inspector,
To expire on 05/14/2027.
Contractors:
Required Inspections:
ELECTRICAL- ROUGH, PLUMBING , ELECTRICAL-FINAL, FINAL,
Fees:
As Built Alteration $500.00
ELECTRIC -Residential $200.00
CO-RESIDENTIAL $100.00
Total $800.00
wilding 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) 765-9502litt ://www.southpi(ito°N rij2y.00
Date Received
APPLICATION I
,4
'
For Office Use Only
PERMIT NO. Building Inspector: APR 4 2025
Applications and forms must be filled out in their entirety.Incomplete Building Department
applications will not be accepted. Where the Applicant is not the owner,an Town of Southold
Owners Authorization form(Page 2)shall be completed.
p eted.
Date:4/5/25
OWNER(S)OF PROPERTY:
Name:Cliff Cornell SUM#1000-473889 61.-1-8.1
Project Address:
Phone#:9176909729 Email:raineyclif@yahoo.com
Mailing Address:53245 Main Road Southold NY 11971
CONTACT PERSON:
Name:Cliff Cornell
Mailing Address:10946 North Bayview Road
Phone#:9176909729 Email:raineyclif@yahoo.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:Current Electrical And Lighting/ Eric Williams
Mailing Address:.
Phone#:631-466-5904 FEmail:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
DOther HVAC $23000
Will the lot be re-graded? ❑Yes RNo Will excess fill be removed from premises? ❑Yes MIND
1
PROPERTY INFORMATION
Existing use of property:Vacant Intended use of property:TBD
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Hamlet Business this property? ❑Yes ®No IF YES, PROVIDE A COPY.
8 Check Box After Read!rmg: 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.
Cliff Application Submitted By(print name): ❑Authorized Agent R Owner
Signature of Applicant: Date: 4/5/25
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01 BUe186050
Qualif led In Suffolk County
COUNTY OF, ) Commission Expires April 14,2 02a Q
.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 i 20s�� \��
Notary Public
(Where the applicant is not the owner)
I, residing at
Ada 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
off BUILDING DEPARTMENT-Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
raN y Southold, New York 11971-0959
Telephone (63�1)py�7p�65-1�y8f02�-W�y FAX
'yy (6�3e�1y)f7ry6^y5q_^-9p^,5ryp02p �qv�
F;A;mW,.�w7'N A h:3 V.�WItWJ'.�MM 1�'ry 11 R x-"i..�bl +.'b'�LdnW.9 '-i'M"�«.7'Gtt�W�6wF'I'�.dAtl'hfnl I n 'W.A V
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Dater
Company Name: c,a-z
Electrician's Name:
License No.: s% Elec. email: cow+
Elec. Phone No: & - sl oq ❑I request an email copy of Certificate of Compliance
Elec. Address.: tv p z7n,
JOB SITE INFORMATION (All Information Required)
Name: CIJFP z e.,..
Address: , R4 JIIA/
Cross Street:
Phone No.: - -
BIdg.Permit#: email:
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: ® YES N [_]Rough In Final
Do you need a Temp Certificate?: YES NO Issued On
Temp Information: (All information required)
Service SizeE1 Ph3 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? Y ON
Additional Information:
PAYMENT DUE VVITI-I APPLICATION ATION