HomeMy WebLinkAbout51926-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#: 51926 Date: 05/16/2025
Permission is hereby granted to:
Peter J Coolidge
90 East End Ave Apt 17B
New York, NY 10028
To:
legalize (2) "as built" mini-split HAVC units as applied for,
Premises Located at:
405 Oceanic Ave, Fishers Island, NY 06390
SCTM#9.-7-8.6
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 https://wwwsoutholdto%vnnV,,go
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
4
PERMIT NO. Building Inspector;
a
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:
OWNER(S)OF PROPERTY: P
Name: ! SCTM# 1000-
Project Address: "� r hr
Phone#: �I Z 2 �1�" Z2J`I Email:
Mailing Address: , .ku
CONTACT PERSON: _ `�C,
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 ' lition Estimated Cost of Project
❑New Structure ❑Addiitiorr i❑Alterati n ❑Re Repair ❑Demo
ther "A N $
Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ❑No
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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? ❑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.
Application Submitted By(`print name): - er 6 Nµ ®Autlhorized eltt ner
Signature of Applicant: re��� [J' -Mµ_ Date: *
STATE OF NEW YORK)
SS:
COUNTY OF fAA2 k )
wcoo t e, 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
4 (1.7)
day of I V l JA K 20_LZ2
CORINNE M OVERBERG Notary Public
Notary Public,State of New York
No.01 OV6410102
Qualified In New York County
Commission Expires October 19,202PROPERTY OWNER ER U'7"HORIZ 7 ION
(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
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fl BUILDING DEPARTMENT- Electrical Inspector
W' TOWN OF SOUTHOLD
u Town Hall Annex- 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
671
Telephone (631) 765-1802 - FAX (631) 765-9502
ti
� 'a mesh @southoldtownn ov - seand southoldtownn . ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (AiI information Required) Date:
Company Name: e" L*& t)k I
Electrician's Name: ,l
License No.: 0 f-Z Elec. email: e' rQL
Elec. Phone No: I request in email copy of Certificate of Compliance
Elec. Address.: cr os ji
JOB SITE INFORMATION (All Information Required)
Name:
Address:
Cross Street:
Phone No.:
Bldg.Permit#: email:
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIP ION OF VV RIB,
INCLUDED SQUARE FOOTAGE (Please Print Clearly):
c e , Celt W
�P ray p a� i`�c•Z v j Square Foota e:
Circle All That Apply:
Is job ready for inspection?: YES F-I NO [:]Rough In Final
Do you need a Temp Certificate?. YES NO Issued On
Temp Information: (All information required)
Service SizeF]1 Ph 3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 2 H Frame R Pole Work done on Service? Y N
Additional Information:
PAYMENT' DUE WITH APPLICATION
- MITSUBISHI
ELECTRIC
SPLIT-TYPE AIR CONDITIONERS
INDOOR UNIT � F
MSZ-GL06NA MSZ-GL09NA
MSZ-GL12NA MSZ-GL1 SNA
I.W,
OPERATING INSTRUCTIONS For user
• To use this unit correctly and safely, be sure to read these operating in- •
structions before use.
MANUAL DE INSTRUCCIONES Para los clientes
• Para utilizar esta unidad de forma correcta y segura. lea previamente • - •
estas instrucciones de funcionamiento.
NOTICE D'UTILISATION A('attention des clients
• Pour avoir la certitude d'utiliser cat appareil correctement et en toute
securit6,veuillez lire cette notice d'instructions avant de mettre le climati-
seur sous tension.
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