HomeMy WebLinkAbout52086-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#: 52086 Date: 07/10/2025
Permission is hereby granted to:
South Dyer LLC
PO BOX 86
Orient, NY 11957
To:
legalize "as built"window replacements to an existing single-family dwelling as applied for.
Premises Located at:
21920 Route 25, Orient, NY 11957
SCTM# 17.-6-14.3
Pursuant to application dated 07/09/2025 and approved by the Building Inspector.
To expire on 07/10/2027.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
CO-RESIDENTIAL $100.00
Total 600.00
Buy irp Inspector � �
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TOWN OF SOUTHOLD—BUILDING DEPARTMENT
0� ' Tomm Fall Annex 54375 Main Road P_O Box 1179 Southold,NY 11971-0959
Telephone 631 765-1802 Fax 631 765-9502 https://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
� CE0 [Uf
For Office Use Only
PERMff NO. Building Insp tor:
Applications and forms must be filled out in their entirety.Incomplete Building D Town of Southold
t
applications will notbe accepted. 1Nhere the Applicant Is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
d3ate:
OWINER(S)OF ROPERTY
Name: P L L SUM#1000-
Project Address: 4 ° "
Phone#: Email:�12 - f vl is vl;a 4U�Ad/ .Coni
Mailing Address: Orient,
CONTACT-PERSON:
Name: L .I
� rJ/1/ 11 h 1OW2 AM �G7i F r L.LL D
Mailing Address: . v. � i
Phone#: �f Email:
DESIGN%PROFESSIONAt INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑ ,Iteration ❑Repair ❑Iemoltio Estimated Cost of Project:
Other 0(� t � �`
Will the lot be re-graded? ❑Yes;ZNO Will excess fill be removed from premises? ❑Ye51�o
1
PROPERTY INFORMATION
Existing use of property: & Intended use of property: Res/. o—,l
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property?XYes❑No 1F YES, PROVIDE A COPY.
Q Check Box After IReading. nw owner/cowactor/design pro mad',Is responible for all drainage and storm water issues as provided by
736 of tha7owo Code CA i3K is MEW MADE to the 8WIding.lDepattment for the issuance of a buildirtg Permit pursuant to the"s um Zone
ordinance of the Town of Southold,Suffolk,County,New York and other applicable laws,Ordinances or Regulations,for the construction of buildings,
additlorws,alt trations odor remoaai or demotitlon a3 heeeb+d e c The applicantagreestocomplywfth A applri'cable laws.ordinatux3,bu0ding bode,
housing code and regubdons,and to admit authorized Inspectors on premises and in building(s)for necessary lnspectkms.False statements made herein are
pordshableas aiMiss A mbdemeaft0f porsuanttoSecamil0ASioffheldewY=t'Stale'Penal taw.
Application Submitted By(print name): j"(,- l ❑Authorized Agent 2 wner
�
Signature of Applicant: Date: `7/l 8 ,�
CONNIC D.LUNCH,
STATE OF NEW YORK) Notary Public,State of New York
No.01 BU6185050
SS. O• ualified in Suffolk County
COUNTY OF ) Comrnfls ion Expires April 14,2-DI
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 knowledgeand belief;and
that the work will be performed in the manner set forth in the application file therewith.
-Sworn before me this
Jday of � � ,�
Notary Pubk
PROPERTYOWNER AUTHORIZATION
(Where the applicant is not the owner)
1, 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
2
BUILDING DEPARTMENT-Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex- 54375 Main Road - PO Box 1,179
Southold, New York 1 1 971-0959
407 Telephone{631) 765-1802
APPLICATIOU FOR ELECTRICAL INSPECT-IO
ELECTRICIAN INFORMATION-(All Inforniation-Requimd) Date;
Company Name:
Electrician's Name:
License No.: Elec. email:.
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Rewired)
Name: L d,
Address: 1.2 d
Cross Street:
Phone No.: 1 —//2
BIdg.Permit#: email: J r%, a iv)i4- COAL
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK INCLUDE SQUARE FOOD�A�GE (Please C�t Clearly):
,}Sle�fr l Me+t Pan s j0ah e L
S uare Foota e:.
Circle All That Apply:
Is job ready for inspection?: YES NO [:]Rough In Final
Do you need a Temp Certificate?: , YESMNO Issued On
Temp Information: (All information required)
Service Size1 Ph❑3 Ph Size: A #Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
Linder round Laterals Ll 1 0.2 H Frame Pole Work done on Service? Y nN
Additional Information:
PAYMENT DUE WITH APPLICATION