HomeMy WebLinkAbout51987-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#: 51987 Date: 06/11/2025
Permission is hereby granted to:
Stephanie Puntillo
1525 W Mill Rd
Mattituck, NY 11952
To:
install generator as applied for. Protection from vehicle impact will be required..
Premises Located at:
1525 Mill Rd, Mattituck, NY 11952
SCTM# 106.-9-8.1
Pursuant to application dated 05/05/2025 and approved by the Building Inspector.:
To expire on 06/11/2027.
Contractors:
Required Inspections:
Fees:
GENERATOR $125.00
ELECTRIC -Residential $100.00
CO-RESIDENTIAL $100.00
Total $325.00
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 htt : lwwNv.sout,holdtowti . ov
x,
Date Received
APPLICATION FOR BUILDING PERMIT
q6 For Office Use Only
PERMIT NO. Building Inspector-
Applications and forms must be filled out in their entirety.Incomplete ElUlldlIng Department
i applications will not be accepted. Where the Applicant'is not the owner,an T+ w �Of SOUtI101d
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name; `�� l SCTM#1000-
Project Address: ` 5 Z �► :1� � }; �,�.�. , t\,Y I k cl SZ
Phone#: ') 3�c( '2-6 3 S Email: Zt,e; `%c, r Q Mc�e I .C-O&\
Mailing Address: Mal lu M��-�, �-�.�=-� ,f\J
CONTACT)IERSON:
Name:
Mailing Address: Zoo Jcv a\-�0\
Phone#: 6 U�3 Email: br vL `" �r tit• i �Y
DESIGN PROFESSIONAL INFORMATION:
Name:
Y
Mailing Address: (2)3og 6>Cev 1, 'V,-b 3e>o—i4c) J 1�d 1071
Phone#: 63! Email: 10VC,C-00Cs5►a!T 4MA, N-1
CONTRACTOR INFORMATION:
Name: :.
W O. F—i�C— P— C,
Mailing Address: �� f S�(� �l (�7
Phone#: v3 J-�7(77, a3 Email:1>r0ca-os:za lzC� (9 N"F'L(.mo o nn
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes Plo Will excess fill be removed from premises? ❑Yes ❑No
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 C/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 premisestand in building(s)for necessary inspections.False statements made herein are
punishable as p Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By sprint name): - UC,L Q s i ctl MAuthorized Agent []Owner
Signature of Applicant: �� Date: 4/-a0
STATE OF NEW YORK)
SS:
COUNTY OF )
_Iry c.t, 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 a __ ' 20�C Notary
Public
RICHARIDMAVRO
PROPERTY OWN E R,AILITHORIZAT ftblic StSte of Now York
(Where the applicant is not the.owner) No. OIMA4966164
Qualified'in Kin It C. 0
CofxnM n Expire �` k
%11(o
residing at�_� ti I &A
do hereby authorize to apply on
my behalf a Town of Southold Building Department for approval as described herein.
er's Signature Date
Print Owner's me
2
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
.� M Southold, New York 11971-0959
. "" Telephone (631) 765-1802 - FAX (631) 765-9502
"w, rogerr@southoldtownny.gov - seand sootholdtownn .gow
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: 'eT +
Electrician's Name:
-
License No.: 0 14(Dd L4 Elec. email: imI
Elec. Phone No: []t"request an email copy of Certificate of Compliance
Elec. Address.: l 1
JOB SITE INFORMATION ],(AII Information Required)
Name: Z�c ICI 1� c
Address: i
Cross Street:
Phone No.:
Bldg.Permit#: S 9 -7 email:
Tax Map District: 1000 Section,. Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
GC - Go Sgtaare Footage:
Circle All That Apply:
Is job ready for inspection?: YES NO F-]Rough In Final
Do you need a Temp Certificate?: F-1 YES 0 NO Issued On
Temp Information: (All information required)
Service Size1 Ph3 Ph Size: A #Meters Old Meter#
❑New Service Fire ReconnectOFlood Reconnect OService Reconnect oUnderground OOverhead
# Underground Laterals LJ_1 2 H Frame Pole Work done on Service? Y N
Additional Information: LJ
PAYMENT DUE WITH APPLICATION
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