HomeMy WebLinkAbout52791-Z TOWN OF SOUTHOLD
~° r� BUILDING DEPARTMENT
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SOUTHOLD, NY
Aulm.,
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONESET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52791 Date: 03/26/2026
Permission is hereby granted to:
185 Rambler Rd LLC
2 East End Ave Ph M
New York, NY 10021
To:
legalize "as built"central air conditioning as applied for.
Premises Located at:
185 Rambler Rd, Southold, NY 11971
SCTM#88:5-29
Pursuant to application dated 02/20/2026 and approved by the Building Inspector.
To expire on 03/25/2028.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
CO-RESIDENTIAL $100.00
Total 600.00
*"gwilding Inspector
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P � r —BTIILI)II' DEPARTMENT T
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a P. C3. Box 1 79 Southold, 11971-0959
Town Hall Annex 54375 1n Road .,
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Telephone + 31 75-10a (631) 75-9502hf 'wwwsotrt� oldt °w,n,n . �
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Date Received
APPLICATION FOR BUILDING PERMIT
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PERMIT NO, BuildingInspector-. �� � �
Bull iin
Applications and forms rust be filled out in their entirety. Incomplete
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applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shell be completed.
i
Date:
OWNER(S) OF PROPERTY:
Name: Dr. Morten Jacobs SC M #1000-088-5-29
Project Address: 185 Rambler Rd, Southold NY 11971
Phone 4:212-249-485+ Email:mic anlana@aol-Corn
Mailing Address;
2 E. End Ave, PHI M, New 'Fork NY, 110021
CONTACT PERSON:
Name-
Mailing Address:
Phone : Email,-
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address,
Phone#: Email:
i
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ClAlteration O Repair C71 Demolition Estimated Cost of Project:
d Oth e r As-Built Central Air Condition $1000
Will the lot be re-graded? Yes No Will excess fill be removed from premises? ❑Yes *No
PROPERTY INFORMATION
MATION
Existing use off pro rty- Res. Intended use of property:Res.''
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Roo this property? ❑Yes No IF YES, PROVIDE A COPY.
Check Box After ear Reading.' The owner/contractor/design professional is responsible forall 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 rather 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.
� r. Morton Jacob
CAuth riz d Agent
ent ROwnerAppllcatlon Submitted (print nam
Signature of Applicant. WIN Date:
STATE OF NEW YORK)
SS:
CO U NTY OF 104 �� )
Cyr. Morton Jacobs .
bung duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(Contractor,Ageni, Corporate Officer, etc.) M
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 -,�����
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fart'Public
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000.
op
� ROPERTYOWNER AUTHORIZATION
ONO,
(Where the applicant is not the owner)
1, 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 Gate
Print Owner's Name
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4_7 "o,
BUILDING DEPARTMENT- Electrical Inspector
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TOWN OF SOUTHOLD
° Town Hall Annex - 54375 Main Road - PO Box 1179
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� Southold New York 11971 0959
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Telephone (631) 765-1802
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APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All information Required) Date
Company Name: *Town Inspection*
Electrician's Name,,-
License No.: Elec. email.-
El I request_Elec. Phone No: _ an email copy of Certificate of Compliance
Elec. Address..
JOB SITE INFORMATION (All Information Required)
Name: Dr. Morton Jacobs
Address: 185 Rambler Rd, Southold NY 11971
Cross Street: Main Bayvi ew
Phone No.. 212-249-4856
Bld .Permit#. Cl I I
email: micsanlanaaol.com
Tax Map District: 1000 Section: 088 Block: 05 Lot: 29
!BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
As-Built Central Air Conditioning
uare Footage- 1
Circle All That Apply:
Is job read for ins ection?: ✓ YES []
NCJ Rough I n Final
y P
Do you need a Temp Certificate?, YES NO Issued On
Temp Information: (All information required)
Service Size 1 Ph 3 Ph Size: A # Meters
Old Meter#
Fir Reconnect[]Flood Reconnect[:]Service ReconnectFlunderground ❑overhead
Near service❑ e R.eco ❑
# Underground Laterals 1L:]2.,.[] H Frame Pole Work done on service?
Y r IN
Additional Information:
PAYMENT DUE WITH APPLICATION