HomeMy WebLinkAbout52816-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#: 52816 Date: 03/31/2026
Permission is hereby granted to-,
Warke V Revoc Trt
286 Midline Rd
Freeville, NY 13068
To:
install HVAC system to an existing single-family dwelling as applied for.
Premises Located at:
2500 Hobart Rd, Southold, NY 11971
SCTM# 64A.7
Pursuant to application dated 03/06/2026 and approved by the Building Inspector.
To expire on 03/30/2028.
Contractors:
Required Inspections:
ELECTRICAL- ROUGH, PLUMBING , ELECTRICAL- FINAL, FINAL,
Fees:
HVAC $250.00
CO- FSIDENTIAL $100.00
Total $350.00
Tiding Inspector
i 1'
° 'SOWN OF So OLD BUILDING DEPARTMENT
7 Southold NY 11971-0959
'Town Hall Annex 54375 Main Road P. 0. Box 1179 ,
r
Telephone(631) 75-1802 Fax (631 765-9502haps: 4 . ot .o� o
t
Date Received
LZ L
APPLICATION FOR BUILDING PERMIT
For office Use only
6�I
I
PERMIT NO►.
BuildingInspector-
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
fees Authorization form(Page 2)shall be completed.
Date:312126
OWNER(S)of PROPERTY:
Name:Andrea L.StmrtCh Revocable Trust&Val Warne Revocable Trust SCTM#1000-64-3-7
Project Address:2500 Hobart Road
Phone#:607Email:als34@cornell.edu
5339 �
Mailing Address:286 Midline Road Freeville NY 13068
CONTACT PERSON:
Name:Andrea Simitch
Mailing Address:286 Midline Road Freeville NY 13068
i
Phone#:607 216 5339 Email:als34@cornell.edu
DESIGN PRoFESSIONAi.INFORMATION:RMATION:
Name:NA
..........
Mailing Address:
P
Phone#: _ Email:
CONTRACTOR INFORMATION:
Name:John Zurawski KOLB Heating and Cooling
Mailing Address: Sound Ave Mattituck, NY,11952
Phone#.831 298 5527 Email:john@kolbmechanical.com
DESCRIPTION of PROPOSED CONSTRUCTION
O New Structure ❑Addition DAlteration D Repair O Demolition Estimated Cost of Project:
0Other installs ion of AC sytem with two exterior condensing units $37,655.00
Will the lot be re-graded? ❑Yes O No Will excess fill be removed from premises? DYes M No
t
PROPERTY INFORMATION
Existing use of ` intended use of property:residential
property:� residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Dyes ❑No IF YES, PROVIDE A COPY.
19, m � mmi
° Check After�� uumwrillllllllllmI��IIII ��� The anwner/aontracltor/'deslp pnofiesslonal Is responsible for all drainage and storm water Issues as pmolded by
CA71ON IS HEREBY MADE to the Build 1�e cat for the issuance of a Building Permit pursuant to the Building Zane
Town Code. APPII parl�rne
� Chapter 2,S�r�the M�
ordinance of the Town of Southold,Su#halc,County,Now York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alter�atiom or fair removal or demolition herein described."the applicant agrees to comply with all applicable laws,,ounces,building rode,
housing code and regulations and to admit authorized Inspectors on premises and in butiding(s)for necessary Inspection&False moments made herein am
punishable as a Cim A misdenneanor pursuant to Section 210AS of the New York State Penal Low.
Andre Sirinitch Application Submitted By(print n me,
❑Authorized Agent owner
Signature of Applicant: Date: 3/2/26
� pp Ni
STATE OF N EW YO R K)
5S:
COUNTY OF lnej?,
i
- - being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
(Contractor,AAgent,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 e rei "th.
Sworn before me this
'?4,o,,.
day of ` Zi
No Public
('.* .01 SELLE
PROPERTYVr* 'ton No. .
(Where the applicant is not the owner) Q �i,IIfi ii "'�,� iff C � '
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 Gate
Print Owner's Name
2