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HomeMy WebLinkAbout53262-Z 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#: 53262 Date: 09/11/2026 Permission is hereby granted to: Savona John L Irrevoc Trt PO BOX 884 Shoreham, NY 11786 To: Legalize as built alterations to an existing single-family dwelling as applied forto include HVAC system and "in-kind"replacement windows. Premises Located at: 8275 Skunk Ln, Cutchogue, NY 11935 SCTM# 104.-3-10 Pursuant to application dated 08/14/2026 and approved by the Building Inspector.. To expire on 09/10/2028. Contractors: Required Inspections: Fees: As Built Alteration $500.00 CO Single Family Dwelling-Addition /Alteration $100.00 Total $600.00 �_ Building Inspector ��� ©( �e t r „ TOWN OF SOUTHOLD—BUILDING DEPARTMENT PIS Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 1 1 97 1-0959 �yf Telephone (631) 765-1802 Fax (631) 765-9502 hM ://wwww.soutlioldtoLA _ o�v Date Received APPLICATION FOR BUILDING PM MIT For Office Use Only E E PERMIT NO. c a 01 Building Inspector. Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant is not the owner,an Building[department Owner's Authorization form(Page 2)shall be completed. Town of Southold Date: o XQ & OWNER(S)di PROPERTY, Name: /9vv,)t9 JU�91iJ lr/eac6lc? 7/ir�ST SCTM# 1000- ��y `�� 'Ib Project Address: l7a 7S 5)z yWh- 1,ene Ctt tug N y Phone#: 7a 90 to 3r .- -as 78 Email: U U*Ld i, � �6-Z cam/ Mailing Address: /00. /3U� d�fO c/ iY, CONTACT,PERSON: Name: To-se To-sed, A S c;oN19 Mailing Address: U. kOX ore S`7o/eX,i I0 Y. //7,?& Phone#:Ced( 3i) 3 7g 90 63, ti2a 7T? 1 Email: J Ue®Sf��"DitJ ,2/Afi,(I�rG�N DESIGN PROFESSIONAL INFORMATION: Name: 7� Mailing Address: `090-oq6'9 Phone#: E mail: CONTRACTOR INFORMATION: Name:. Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alterati n ❑Repair ❑D ollt' stimated Cost of Project: Will the lot be re-graded? ❑Yes ❑No WiR excess fill rex v e)8 romp ises? ❑Yes F l 17:e 1 PROPERTY INFORMATION Existing use of property: �5;/de0"rL 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 ONO 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 220.45 of the New York State Penal Law. Application Submitted BY(print na : JMSeV CJ�U��� E]Authorized Agent ❑Owner Signature of Applicant: ,y e --� � Date: STATE OF NEW YORK) COUNTY OF " ) �, )0 vnh � - &/ �(� being duly sworn, deposes and says that(s)he is the applicant (Name of inklividual signing contract)above named, (S)he is th ouj (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 Pawl, -----� / ° dais of us� 201 �� otai r�Puubli PEGGGY B.HUBBARD NOTMY R•STATE OF 'VM PROPERTY OWNER AUTHORIZATION C ALIF'NGCt Nr sffm IWIX111140011EXPIRESIAW31,30 (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 � tldtg Hall Annex - 54375 Main Road - PO Box 1179 "fsw MCA r> Southold, New York 11971-0959 Telephone (631) 765-1802 APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All Information Required) Date: Company Name: Roslak Electric Inc. Electrician's Name: Torn J. Roslak License No.: Elec. email: Elec. Phone No: (631) 765-4611 ❑I request an email copy of Certificate of Compliance Elec. Address.: 40 Oriole Drive, Southold, NY 11971 JOB SITE INFORMATION (All Information Required) Name: Savona- Address: 8275 Skunk Lane, Cutchogue, NY Cross Street: Corner of Pine Tree and Skunk Phone No.: (631)384-7290 (Cell -Joe Savona) Bldg.Permit#: 5-2)a �f 2 email: Joe@sav-onprinting.com Tax Map District: 1000 Section: 10 L� Block: Lot: (Q BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): VAC condensor cA- Msiiv\ t-16-uSe 6jc� eo-- Square Footage: Circle-All That Apply: Is job ready for inspection?: 1 YES NO Rough In Final Do you need a Temp Certificate?: 0 YES NO Issued On Temp Information: (All information required) Service SizeF11 Ph FJ3 Ph Size: A # Meters Old Meter# ❑New ServiceQFire Reconnect OFlood Reconnect nService Reconnect QUnderground Overhead # Underground Laterals 0 1 2 M H Frame Pale Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION