HomeMy WebLinkAbout52115-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#: 52115 Date: 07/18/2025
Permission is hereby granted to:
Head of Harbor LI LLC
2631 Merrick Rd
Bellmore, NY 11710
To:
Install a generator accessory to a single-family dwelling as applied for. Must maintain a minimum side
and rear yard setback of 25 feet.
Premises Located at:
19620 Soundview Ave, Southold, NY 11971
SCTM# 51.-3-12.3
Pursuant to application dated 06/26/2025 and approved by the Building Inspector.
To expire on 07/18/2027.
Contractors:
Required Inspections:
Fees:
GENERATOR $125.00
CO Accessory $100.00
ELECTRIC -Residential $100.00
Total $32S.00
Building
g Inspector
tiw 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 :// N w, oulholdt w n . o
Date Received
APPLICATION FOR BUILDING PERMIT E C E OVE
For Office Use Only
p
JU 2025
PERMIT NO. 5 a115 BuildingInspector.,
Applications and forms must be filled out in their entirety. Incomplete Building Department
applications will not be accepted. Where the Applicant is not the owner,an Town of Southold
Owner's Authorization form(Page 2)shall be completed.
Dater
OWNERS)OF PROPERTY:
Name: -- SCTM # 1000- - -
�: t d� - �. Ll LLB 0.3/, V --v 3.GD - Cyr 003 i
Project Address: / _ /
[Phone#: -Yiz ' Email: � 44 L,
Mailing Address: f
CONTACT PERSON:
Name: ,eLknJ�c�
Mailing Address: �1� �vX dv / SL/ l
Phone# Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
GS t NC.
Mailing Address: r�li y /9&4.2 0 s
Phone#: _� /. 3 iXl /C 2 Email:,,, (d] (� A/VL.
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes ❑No 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? Dyes El 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): ❑Authorized Agent Plowner
Signature of Applicarlt. Date:
STATE OF NEW YORK)
S:
COUNTY OF �)
�IL6 4 Q �q n v being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Q .�n
(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
6 day of y UA L e- 20 .
Notary Public
Notary Public »Slate of Now York
No.. O I OL0019699
P NEB lI ( Qualified in Suffolk Count10, y
Idly Comm, Expires Jan. 0, '208
(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
2
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
"r Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: �e AAj -
Electrician's Name.
License No.: Elec. email: 7j
Elec. Phone No: - _ - ❑I request an email copy of Certificate of Compliance
Elec. Address.: m ll
JOB SITE INFORMATION (All Information Required)
Name:
Address:
Cross Street:
Phone No.:
Bldg.Permit#: of ( email:
Tax Map District: 1000 Section;1>'goo Block: 03 Lot p/.
(BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES NO F]Rough In ElFinal
Do you need a Temp Certificate?: El YES 0 NO Issued On
Temp Information: (All information required)
Service SizeF11 Ph EJ3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect[]Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 2 LJ H Frame El Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
IMPROVED RESIDENTIAL LOTS
WELL HATER
NO WELL5 WITHIN
150 PT. OF 5UB.JEGT PROPERTY
r
50U�
o
mweKax
Tom
"x —
;rn
I i
1
1
t
_
I
3 i I
>
z FUTURC
z
v # U
UJ
p 0 O
r rtfi i M XI
1 r ,ti
rat z � � ' � p O
� r
v
7K r
o _
v t
o 1
v
ul
-
Z � ..
145.52'
W I LD5ERR"To' LANE
� IMPROVED LOTS
g
In PUBLIC HATER
N