HomeMy WebLinkAbout53277-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#: 53277 Date: 09/16/2026
Permission is hereby granted to:
W Hamrogue Donahue
13700 Oregon Rd
Cutchogue, NY 11935
To:
legalize central air conditioning in an existing single-family dwelling as applied for.
Premises Located at:
13700 Oregon Rd, Cutchogue, NY 11935
SCTM# 83.-3-1
Pursuant to application dated 08/27/2026 and approved by the Building Inspector.
To expire on 09/15/2028.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
CO-RESIDENTIAL $100.00
Total $600.00
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Building Inspector
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 fit //www.southoldto vr�r� aY
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only r
PERMIT NO. Building Inspectors,_
2 7 r U'r, �
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed. Tc,'w-: <A' S out; c'dd
Date:
OWNER(S)OF PROPERTY:
Name:�,�/J /U1 %'� SCTM #1000-
Project Address: �� �� �!' � �C� � �3
Phone#: Email;
Mailing Address;
CONTACT PERSON:
Name; ,e1r'8
Marling Address: �—� r" ZZ
� � "
Phone#: Email:
DESIGN PROF
ESSIONAL INFORMATION: �
Name.-
Mailing Address:
Phone#; Email:
CONTRACTOR INFORMATION:
Name: �-
Mailing Address:
Phone#; _ Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ElAddition ❑Alteration ❑Repair ODemolition Estimated Cost of Project:
%other $--— — .
Will the lot be re-graded? ❑Yes XNo Will excess fill be removed from premises? ❑Yes KNO
1
PROPERTY INFORMATION
Existing use of property: /,, "'7� 4 1 C Intended use of property:„
Zone or use district in which premises is situated; Are there any covenants and restrictions with respect to
e
this property? ❑Yes gNO IF YES, PROVIDE A COPY.
NL Check BOX After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 256 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.
WiIV Ares pqm P, ' ur M 0 �41 <-
Application Submitted By(print name): ❑Authorized Agent XOwner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF-- " C� r )
�r _ being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signin contract) above named,
(S)he is the� („ �?J 12_- r
(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
day of �" ' `JT 20�
NotbyPu ic
I O S J.UHLINQER
Now"public,State of New
01UH4a PROPERTY OWNER AUTHORIZATION
"I"I'dIn C'ou f (Where the applicant is not the owner)
Comfeslon Expires Feb.26,X
77
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
` a TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
,q Telephone (631) 765-1802
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) 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)
Names
Address: /17 6b Li e 1 a
Cross Street: Cx.-
Phone No.:
BIdg.Permit#: -' email• p 7, .
Tax Map District: 1000 Section: Block: j Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: YES FI NO F-]Rough In El Final
Do you need a Temp Certificate?: El YES [:] NO Issued On
Temp Information: (All information required)
Service Size[-11 Ph R3 Ph Size: A # Meters Old Meter#
❑New Service0 Fire Reconnect El Flood Reconnect FlService Reconnect OUnderground❑Overhead
# Underground Laterals 1 2 D H Frame Pale Work done on Service? Y ON
Additional Information:
PAYMENT DUE WITH APPLICATION