HomeMy WebLinkAbout52815-Z TOWN of SOUTHOLD
LD B c U I I N S DEPARTMENT
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MIDST BE KEPT ON THE PREMISES
WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52815 Date: 03/31/2026
Permission is hereby granted to:
Christine Rendel
55 North Dr
Mattituck, NY 11952
To:
legalize "as built" mini split units to an existing single-family dwelling as applied for.
Premises Located at:
145 North Dr, Mattituck, NY 11952
SCTM# 106.-6-17.1
Pursuant to application dated 03/06/2026 and approved by the Building Inspector.
To expire on 03/" 0/2028.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
CO-RESIDENTIAL $100.00
Total S600.00
Building Inspector
' n TOWN OF �OUTHCJLD—BUILDING DEPARTMENT
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Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax(631) 765-9502 lit s-,H .s �ovy(
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Date Received
APPLICATIDN FOR BUILDING PERMIT
For Office Use only 4 p M
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PERMIT NO. .
Building�n� e��� � �
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Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. 'Where the Applicant Is not the owner,ann
owner's Authorization farm(Page 2)shall be completed. P����� ,n�
Date.
OWNER(S)OF PROPERTY:
N a m e: �?.,,� I '�.` „ —. SCTM#�.00D- "' ,`q to 6�.
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...........
Project Address: E C-1:t=l 4-S ck4 rA),,,, ktA-P
Phone#: t `1 z gi5 bC)-L Email: C re 1 d 6) M P, - con,
Mailing Address: ' D IZA VzF
CONTACT PERSON:
Name: C W2..�V�Ia t L__;:
Mailing Address: Z)au vz'7 TL4C<-'- N
Phone#: q �-JEmail: cy-�
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DESIGN PROFESSIONAL INFORMATION:
Name.
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Mother r*J 1... -'
Will the lot be re-graded` ❑Yes EiNokk Will excess fill be removed from premises? DYes CBNo
INN
....................... ............. ........
..........................
PROPERTY INFORMATION
Existing use of propertys Intended use of-D rope nv:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? 13Yes 3?No IF YES,, PROVIDE A COPY.
MCheck Box After Read111g'.' The owner/contractor/design proftesslonal Is responsible for all drainage and stonin water Issues as provided by
Chapter 236 of the Town Code. AP PUCA11ON IS HEREBY MADE to the Building Department far the Kwance of a Building Permit pursuant to the BuRdIng Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,,fear the construction of bulldInM
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
Mousing code and regulations and to admit authorized Inspectors on promises and In building(s)for necessary Inspecdons.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
..........
Application Submitted By(print name): R(? OAuthorized Agent IXOwner
Signature of Applicant: Date:
CNNIE D.BUNCH
O ,?
Notary Public,State of New York
STATE OF NEWYORK) No.01 BU61 85050
SS: Quallfied In Suffolk County
COUNTY OF COMinisslon Expires April 14,2
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
4-:iD day of 20CQL
Notary Public
PROPERTY OW�N�ii.--w.R ,A�U'mim'�HOR17..,A- TIGN
(Where the applicant is not the owner)
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
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•y mm BUILDING DEPARTMENT - Electrical Inspector
TOWN OF SOUTHOLD
Main Road - PO Box 1179
Town Hall Annex 54375
Sout
hold, New York 1 1971-0959
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Telephone (631) 765-1 89
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E:
ECTR.ICAL INSP C NAPP CATIODate
ELECTRICIAN INFORMATION (All Information Required)
ICompa -�Name� J
E'lectrician's Name:
• Elec. email
License No.. I I
-6�7 1 py of certificate of Compliance
Elec. Phone N a$ � --
�]l request an ema co
El ec. Address.-:
,J O B SITE INFORMATION (Au Information Required)
Names
Address
Cross Street
Phone No
Bldg.Permit #
email.
Tex Map District. 1090 Sec � � Block: Lot.
. 11 (Please Print Clearly):
WORK INCLUDE SQUARE FOOTAGE
BRIEF DE�CRIPTICJN 7
r ) A4 lei .r (i7
Square F oota Le",
Circle All That Apply:
Final
NO Rough I n
read for ins ES 'gIs joby inspection?:P
Do you need a Temp
Certificate?: E:1 YES El NO Issued On
Temp Information
All information required)
Servi
ce Size l[:]1P h[:]3 P h S ize
# Meters.. -n Old Meter#
New service❑Fire R econ nett Flood Recon nect
F]Se rvice Reconnect❑Underground Floverhead
Under round Laterals 1 H Frame
Pole Work done on Service? Y N
Additional Information
Y T DUE, WI APPLICATION