HomeMy WebLinkAbout51925-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#: 51925 Date: 05/16/2025
Permission is hereby granted to:
Peter J Coolidge
90 E End Ave Apt 17B
New York, NY 10028
To;
legalize "as built"central air conditioning as applied for.
Premises Located at:
561 Oceanic Ave, Fishers Island, NY 06390
SCTM#9.-7-8.4
Pursuant to application dated 04/07/2025 and approved by the Building Inspector.
To expire on 05/16/2027.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
ELECTRIC -Residential $200.00
CO-RESIDENTIAL $100.00
Total S800.00
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 htti)s://www.southoldtownu.gov
Date Received
APPLICATION FOR BUILDING PERMIT
"
For Office Use Only
PERMIT NO. 1:9?1 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.
I
Date:
OWNER(S)OF PROPERTY:
Name: � � ti, Cod SCTM#1000- 9 7 o
Project Address: G?,CL6, 4,
Phone#: Email: 64197
Mailing Address;' I >�
CONTACT PERSON:
Name:
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
p i � �� Estimated Cost of Project:
❑NRrO�heStructure ❑Addit alr ❑Demolition E
Ion ❑Aiteration ❑Re
Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ONO
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 c
Application Submitted By(print name): ✓ �`� �r ❑Authorized Agent CI�Owner
Signature of Applicant: f`�O ��'° f Qi Date:
r
a+'
STATE OF NEW YORK)
SS:
COUNTY OF N )
1 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 KucLA, 2A6
CORINNE M OVERBERG Notary Public
Notary Public,State of New York
No.01 OV6410102
Qualified in New York County PROPERTY OWNER AUTHORIZATION
ornmission Expires October 19,2028
(Where the applicant is not the owner)
V, 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 Owners Name
2
BUILDING DEPARTMENT- Electrical Inspector
x TOWN OF SOUTHOLD
~' Town Hall Annex- 54375 Main Road - PO Box 1179
� rft Q Southold, New York 11971-0959
o k �P
fd �° Telephone (631) 765-1802 - FAX (631) 765-9502
a �9 amesh southolr townn m ov - sea nd outhol ltownn cry
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) fl Date:
1017 Company Name: 4r ���K �" ,JAI
Electrician's Name: -fed
License No.: Elec. email:
Elec. Phone No: 011 request ah email copy of Certificate of tompliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name:
Address:
Cross Street:
Phone No.:
Bldg.Permit#: email:
Tax Map District: 1000 Section Block: Lot:
BRIEF DESCRIPT107 OF WOR
P
IN C
a UDE QUARE-f ref �O TAG (Plea Pr t CI rly):
C '
VJ1 , newer- v4,
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES D NO [—]Rough In Final
Do you need a Temp Certificate?: YES Li NO Issued On
Temp Information: (All information required)
Service Size 1 PhD Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 n2 H Frame Pole Work done on Service? n Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
�a mum VI
Air-Conditioners
L~. �� SVZ-KP 12
,18, 24, 30, 36NA
OPERATION MANUAL
For safe and correct use,please read this operation manual thoroughly before installing
the air-conditioner unit.
MANUEL D'INSTALLATION "71'
z " Veuillez lire le Manuel d'installation en entier avant d'mstaller ce climatiseur pour evder
tout accident et vous assurer d'une utilisation correcte.
1�^
51,3
�1
a Y�'• t -
.. al 91 -