HomeMy WebLinkAbout52294-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#: 52294 Date: 09/25/2025
Permission is hereby granted to:
Ronald B Shelton
222 E 80th St Apt 2
New York, NY 10021
To:
construct an accessory pool house as applied for per SCHD approval.
Premises Located at:
1050 S Harbor Rd, Southold, NY 11971
SCTM# 75.-3-14
Pursuant to application dated 08/15/2025 and approved by the Building Inspector.
To expire on 09/25/2027.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $300.00
CO Accessory $100.00
Total S400.00
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 http ,://www.southoldtoAlMy.gov
IY
Date Received
APPLICATION FOR BUILDING PERMIT
1
For Office Use Only
q
�i PERMIT NO.
6 Building
Inspectors--AUG 5 F
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an Build!ng Department
Owner's Authorization form(Page 2)shall be completed. Town of Southold
Date:
OWNER(S)OF PROPERTY:
Name: 96,1 � SCTM # 1000- 11-�-
ProjectAddress: Ll
Phone#: 6 414 `Sq j— 3 -7fb Email:
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address:.
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone
CONTRACTOR INFORMATION:
Name:
Mailing Address: e2f116 7A
Phone#: Email,,I*g, �c
y
DESCRIPTION OF PROPOSED CONSTRUCTION
A�NewStructureAAAdclltion ElAlt+eration ❑1lepair ❑Derinolltion Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes PNo Will excess fill be removed from premises? ❑Yes El 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? ❑Yes ONO IF YES, PROVIDE A COPY.
11� 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): J<x-4 A MAuthorized Agent ❑Owner
Signature of Applicant: Date: �VA&)2-j -
CONNIE D.BUNCH
STATE OF NEW YORK) Notary,Public,'State of New York
SS: No.01 BU6185050
Qualified In Suffolk County
COUNTY OF ) Commission Expires April 14,2 _y
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is 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 knowledge and belief; and
that the work will be performed in the manner set forth in the application file therewith.
Sworn before me this
Ae-,, k day of , 20
Notary Public
(Where the applicant is not the owner)
I, residing at d 50a 44 1-4 ,49,0 "
1101
do hereby authorize ' . to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
AAAK - ----- /12,—Zr�02
Owner's Signature ate
Ae—," & v�
Print Owner's Name
2
� f tit
BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1802 - FAX (631) 765-9502
s
. "amesh southoldtown ov — seared southoldtownn . ov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name: 19 �17' L,
Electrician's Name: Myl<e.. -4PJ&
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: o?J
Address: l6
Cross Street: /*1411
Phone No.::
Bldg.Permit#: email:
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
Square Footage:
Circle All That Apply:
Is job ready for inspection?: El YES NO Rough In Final
Do you need a Temp Certificate?: 11 YES 0 NO Issued On
Temp Information: (All information required)
Service Size 1 PhE]3 Ph Size: A # Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 R2 H Frame Pole Work done on Service? Y F1N
Additional Information:
PAYMENT DUE WITH APPLICATION
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I SOUTH HARBOUR ROAD
ERAFT Fop FRo �-E�Or Oc s;-u 'noN Rp A Call(631)852-57546 48 houm its aD
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olT 11t = 301-011
DATE Timm ''S _ cF No, R- a-.0735.. --- 1j s11EETTIrLe
C? HEALTH
g INFORMATION ON PLOT PLAN TAKEN FROM SURVEY PROVIDED BY: DEPARTMENT
1st 0 LAND SURVEYOR. JOBWMBER
NOTE:ELEVATIONS SHOWN REFER TO NAVD88
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