HomeMy WebLinkAbout53246-Z >f� TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 53246 Date: 09/03/2026
Permission is hereby granted to:
Brian J Tardif
370 Terry Ln
Southold, NY 11971
To:
Construct additions and alterations to an existing single-family dwelling to include windows,doors,
deck repairs and interior renovations as applied for.
Premises Located at:
370 Terry Ln,Southold, NY 11971
SCTM# 65.4-6
Pursuant to application dated 08/17/2026 and approved by the Building Inspector.
To expire on 09/02/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $538.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $638.00
JA L
Building Inspector � �
4115�s rr�,rCA . 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 littps://www.southoldtowruiy.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
, 0
PERMIT NO. 5')Se),,qJ Building Inspector.- AUG 17
Applications and forms must be filled out in their entirety. Incomplete Ds ildi o arlrt V�Tlt
applications will not be accepted. Where the Applicant is not the owner,an Town sir°I'
Owner's Authorization farm(Page 2)shall be completed.
Date: �"'�
- r
OWNER(S)OF PROPERTY:
Name: La ,,-��eyd�+- SCTM# 1000- ._
Project Address: 3-70 "t"`
Phone#: 1110
V Email:
Mailing Address: _ 10�1 .�-
�r
CONTACT PERSON:
Name: PATRICIA C. MOORE
Mailing Address: 51020 MAIN ROAD SOUTHOLD NY 11971
Phone#:631-765-4330 Email:pcmoore@mooreattys.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: ? ��
Phone#: (C,J I ( t Email: )� edttc
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
ONew Structure OAddition Iteration ❑Repair ❑Demolition Estimated Cost of Project:
ROtherNOTICE OF DISAPPRO AL j�k I s� $ GCS E
Will the lot be re-graded? ElYesI�Vo Will excess fill be removed from premises? ❑Yes ANo
1
PROPERTY INFORMATION
Existing use of property: is Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
,,. 4O this property? ❑Yes %o IF YES, PROVIDE A COPY.
IN 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 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 ):PATRICIA C. MOORE TAuthorized Agent ❑Owner
Signature of Applica : ---. Date:
STATE OF NEW YORK)
SS:
COUNTY OF SUFFOLK
PATRICIA C. M OO RE being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the ATTORNEWAGENT
(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
1
d u (�6 I .20�o
ay of µ
tart'Public
TRAC,EY L. DWYE R
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
PROPERTY OWNER AUT ORIZ DTI OW-110.L.IFIED IN SUFFOL.K COUNTY
CtU
(Where the applicant is not the owner) " IlSslcrN ErPIRiS DUNE 30, �0
I, e�/4 ne R41 residing at -10 M7zrN 44 50 C (N
do hereby authorize PATRICIA C. MOORS to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signaturg Date
Print Owner's Name
2
"'`v1 EDj BUILDING DEPARTMENT- Electrical Inspector
" 5S t%, .;; TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
g Southold, New York 11971-0959
` tl;. Telephone (631) 765-1802 - FAX (631) 765-9502
;.. smash outholdtonn . ov— seand southoldtownn ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) '1 ice- 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 Required)
Name: ,
Address: ,
Cross Street:
Phone No.: L2 -
BIdg.Permit#: aA LRD email:
Tax Map District: 1000 Section: Block: ( Lot:
BRIEF DESCRIPTION OF WORK , 'NCLU'DE S M QUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES NO 'Rough In Final
Do you need a Temp Certificate?: FYES E]NO Issued On
Temp Information: (All information required)
Service Size Ell Ph FJ 3 Ph Size: A # Meters Old Meter#
❑New ServiceOFire ReconnectO Flood ReconnectF�Service Reconnect Ounderground[DOverhead
#Underground Laterals 1 2 0 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION