HomeMy WebLinkAbout52118-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#: 52118 Date: 07/21/2025
Permission is hereby granted to:
Laurel Links Cntry Club
PO BOX 307
Laurel, NY 11948
To:
Install 4 electric vehicle charging stations and the required equipment to include conduits, electric
wiring, meter/panel, bollards and signage as applied for per manufacturers specification and
installation.Additional certification may be required.
Premises Located at:
4715 Great Peconic Bay Blvd, Laurel, NY 11948
SCTM# 125.-4-24.23
Pursuant to application dated 05/27/2025 and approved by the Building Inspector..
To expire on 07/21/2027.
Contractors:
Required Inspections:
Fees:
EV Charger $500.00
Electrical-Commercial $400.00
CO Commercial $400.00
Total $1,300.00
Building Inspector
ktPMdC
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 :lww+ r.satti �ltowrmn ,
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO, Building Inspetton.
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Date:May 19th 2025
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Name Laurel Links Country Club Incorporated scTM# loo0 12..w,,,..__ .,,,..., .... _..
Project Address:4715 Great Peconic Bay Blvd, Laurel NY 11948 aka 6400 Maln Rd, Mattituck NY
Phone# 631- 298 �- 4352
352 Email:JLanders a�laurelllnkscc.com
Mailing Address:6400 MAIN RD, MATTITUCK NY 11948
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Name:Jim Landers
Mailing Address:6400 MAIN RD, MATTITUCK NY 11948
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# 631 298 4352 ��.. . _ @ kscc.com
Email JLanders laurellln
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Name:Woodhollow Designs
Mailing Address: 103 School St, Lindenhurst NY 11757
Phone#:5168275916 Email:permits@woodhollowdesigns.com
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Name:Woodhollow Contracting Corp....,__ .......
Mailing Address: 103 School St, Lindenhurst NY 11757
Phone#:516 827-5916 Email:
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El New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
DOther Electricvechile Chargers $45000
Will the lot be re-graded? No g ❑Yes ®No Will excess fill be removed from premises? ❑Yes WNo
1
PROPERTY INFORMATION
Existing use of property: G` 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.
heck 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 bulldings,
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 bullding(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(pri name):W " cn.)rt c,�- uthorized Agent ❑Owner
Signature of Applicant: Date: 's—!
STATE OF NEW YORK)
SS:
COUNTY OF
\C.ha pl being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(Fes 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 know age a 'ELEa
that the work will be performed in the manner set forth in the application file therewith. Notary Publtc-State of Ni w York
NO.OIAP6423078
Qualified in Nassau Co rtv
Sworn before me this My Corn isston Expires Oct4, 2025
day of ,20��
Notary P li
SZOZ 'b po sajldx3 uotssivwwo;F,tw
Azuno0 nesseN ul paglienb
PROPERTY OWNER AUTHORIZATION SLOEVIdvt0'ON
(Where the applicant is not the owner) )jjoA MaN;o azezS-3tland Ajuzgia3'13dVVNIlSl'dH:)
C residing at S lloV G( A✓Q n`.t e
�do hereby authorize » to apply on
my behalf i the Town of Southold Building Department for approval as described herein.
S � �
O er"s Signature Date
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Print Owner's Name
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