HomeMy WebLinkAbout52076-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#: 52076 Date: 07/09/2025
Permission is hereby granted to:
Domeluca II LLC
66 Leonard St 9C
New York, NY 10013
To:
install generator as applied for. Provide protection from vehicle impact.
Premises Located at:
14895 Route 25, East Marion, NY 11939
SCTM# 23.-1-2.10
Pursuant to application dated 06/12/2025 and approved by the Building Inspector.
To expire on 07/09/2027.
Contractors:
Required Inspections:
Fees•
GENERATOR $125.00
ELECTRIC -Residential $100.00
CO-RESIDENTIAL $100.00
Total S325.00
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 17kt �wp. na�tlslcltt �vA�t�� "
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
,J N 12
PERMIT NO. � o � /` Building Inspector:-&::�-
ct
Ap Ilcations ahct forms must be filled out m th'eir entirety.IncompletQ �Rr 110 b'
��
appllat�ons WWII not be accepted Where the dpplic�nt is not the owner,an 'so ent
Qwrfr's Authoriation fprm(bale 2)shall be coinpletd,
Date:6/4/2025
O,WNft(S)OF PRdPERTY:
Name:Pablo Salame ESCTM # 1000-2 3-1-2.10
Project Address: 14895 Main Road East Marion, NY 11939
Phone#: Email
Mailing Address: 14895 Main Road East Marion, NY 11939
'CONTACT PEfSON:
Name:Dale Szabo
Mailing Address:41 Woodland Drive Brightwaters, NY 11718
Phone#:917-714-6467 Email:dales@dowbuilt.com
DESIGN"P{ pF�SS1014i L"INFQRMAT`ION:: ,
Name:Stimson Studio
Mailing Address:288 Norfolk Street Cambridge, MA 02139
Phone#:617-876-8960 Email:dnielsen@stimsonstudio.com
CONTRACTOR;I N FORMATION:
Name:Gary Salice - GJS Electric LLC
Mailing Address:6615 Main Road Mattituck, NY 11952
Phone#:631-298-4545 Email:gary@nfay.com
pESGR1f�TION OF PRCIPOSED`CONS'1 RUCTION
El New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
(]Other New Generator $50,000.00
Will the lot be re-graded? ❑Yes iRNo Will excess fill be removed from premises? []Yes *No
1
7-7 W11
PROPERTY INFORMATIQN
Existing use of property: Residential Intended use of property: Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R80 this property? ❑Yes BNo IF YES, PROVIDE A COPY.
8 r f'q f i 6,adill ig The owner/contractgr/design profess�ary3l�s reSpansibfa for all dralf�age ands srrr6Water Issues as provltle d by
i i
CKap>l�r 2 5 of tfre Tov(in bode 'APPLICATION lS fJ1 Ri;BY MApt:to tke suildmg aepa�tmerttpr„Missunce rsf a Builtiirlg Perm�f pursuart fo tke:Buflding"Zane
O{ Qf the Town of Sautfold, uffblk,County,New,Yoik and'othur applrCble Wws,Ord)nanes or Rem'Jatlans,forthe s�sstructiarr vf:bildings,
a ld ioifs;�alteratilnns r fo'removal or-ddmolrtion as he reirt'desceibecf The a, ffcant aa, to comply v4ifh"ell ¢pl�cab(e(aws,�srdinancas;build+ng cads,
domgJFd4 and regulations andtq ad"mit authorized�n;pectors o�premises and InrU fdjng�sj fssr necessr/irissectfbns 1�I,se sta'temen£s`inade herein ire
pur►ishable a$
`a Class'A°misdemeartor pursuant to Section 210.45 of the New York State;Penal Vaw,
Application Submitted By(print name):Dale Szabo RAuthorized Agent ❑Owner
:11---D (I
Signature of Applicant: Date: 6/4/2025
STATE OF NEW YORK)
SS:
COUNTY OF Suffolk )
Dale Szabo being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Agent
(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 20
Notary Public
PROPERTY OWNER A LITFI R iZA"' li f I
(Where the applicant is not the owner)
Pablo Salame residing at 14895 Main Road East Marion, NY 11939
do hereby authorize Dale Szabo to apply on
my behalf to the Town of Southold Building Department for approval as desc ibd herein.
Owner's Signature Date
Pablo Salame
Print Owner's Name
2
' 1~IB BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
"1 o ` Southold, New York 11971-0959
Telephone (631) 765-1802
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: 6/16/2025
Company Name: GJS Electric
I,
Electrician's Name: Gary Salice
License No.: 14 g313 n)C Elec. email: gary@nfay.com
Elec. Phone No: 631-298-4545 1 request an email copy of Certificate of Compliance
Elec. Address.: 6615 Main Road Mattituck, NY 11952
JOB SITE INFORMATION (All Information Required)
Name: Pablo Salame
Address: 14895 Main Road East Marion, NY 11939
Cross Street:
Phone No.:
Bldg.Permit#: email: dales@dowbuilt.com
Tax Map District:
1000 Section:23 Block: l Lot: 2.10
BRIEF DESCRIPTION OF WORD, INCLUDE SQUARE FOOTAGE (Please Print Clearly)
Installation of 48 kw Generator.
S uaire Footage:
Circle All That Apply:
Is job ready for inspection?: ❑ YES [] NO Rough In Final
Do you need a Temp Certificate?: YES F-] NO Issued On
Ternp Information: (All information required)
Service SizeEl1 Ph 3 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 N
Additional Information:
PAYMENT DICE WITH APPLICATION