HomeMy WebLinkAbout53002-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
COUNT44,
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#: 53002 Date: OS/20/2026
Permission is hereby granted to:
James A Andrews
PO BOX 227
Peconic, NY 11958
To:
install a generator as applied for.
Premises Located at:
772 Indian Neck Ln,, Peconic., NY 11958
SCTM#86.-4-1.11
Pursuant to application dated 05/12/2026 and approved by the Building inspector.
To expire on 05/19/2028.
Contractors:
Required Inspections:
Fees:
GENERATOR $125.00
CO-RESIDENTIAL $100.00
Total $225.00
Building Inspector
TOWN OF SOUTHOLD BUILDING DEPARTMENT
Town Hall Annex 543 75 Main Road P. 0. Box 1179 Southold, NY 11971-0959
Telephone(631) 765-1802 Fax (631) 765-9502
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
-01
)ERM IT NO., ilding Inspector,
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an
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ust be filled out in the'1r
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'iois "ll not be accepted. WheretheAp not the owner,an
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pfitant,l
r' (Page 2)shall be completed
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Date:
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DIE-SIGN PROFESSIONAUNFORMATIONO
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DESCRIPTION OF PROPOSED CONSTRUCTION
MeW Structur I e EAddi`tiol F�Alteration F�Repair DDemolition Estimated Cost of Proie'ctlw,
)�tther $
es nNo
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01 00- lip
011
ON L
r%a I INFORMATI 7,
PROPERIv 71
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Intended use of proper-
sting use of property"# venant nd restrictions with respe,I,IL
Are there any co S r
ituated: 'VNo IF YES,, PROVIDE A COP,
use district in which premises Is s- this property? F�Yes
ne or
andi,storm water issuesas,provided b,
S510031 is relsponsitiie all,641 1 flAge
tractor/desgnplrofe suance of a Soilding,Permit pursvant.to the.Suildin
ID0,partrniOnt f"Ot Is
eadjIngo Tbeownerftol k's''for the CoInw,ulctio,,rtoi'b,,,uildiing,,s,,,,
f Cheick 8,0,x After R , -rJON IS HERE"MADE'to the'Suilldi"S 0 Laws, 1n;ance,,,1 or oeguiatilor, tilding co
tICA ,��orcf ta'ws,otd.inancesr bu I
e,, APIP n her a pvfi Ga bi r�JPN,witih,all,gopticoble
t4,ew York,andot �O C
tapter 2.316 of the�T'01W'n Co'd Offolu"o Cou policantagre'e,"s't 0 LAMM nts,made hervin
e4n destribed The Insp *m,FaiSe A
,#d,na�nc Town-of 50uftl�, it-0,",asher � I for necesiary
of-tho em,01 I and,in bul'141"O'$
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0,n,,,s or for temo(val or d
,,tera�t 's On 'tat
Uthoriza41nsP`eCt0`r e Penal Law.
1,regulationsalnid to admit�a
210,45 of the New'yo*S
0,using,code ant P%jrsuant t,o,Se I
AMj,sdeMe2n0
0Author1zcd Agen�t, Owneir
n(t name)# 5--ld -210
tted BY`�(P Date*
A,ppl*catoon SubMil
to
Signature of APplican
TATE OF NEW YORK)
ISS:
-0 U NTY 0 F g duly sworn, deposes and says that (s)he is the applicant
being
I(Name of i ndividual signing contract) above named,
ggen't,Corporate officer,etc.)
(S)he is the ,,,,��� t(contractor, Ag id work and to make and file this
erform or have performed the sa
of said owner or owners) and is duly authorized to P ication are true to the best of his/her knowledge and belief; and
;that all statements contained in this appli pplication file therewith
application d in the manner set forth in the a
that the work will be perforryie
sworn before me this A
ota ry ublic
I\A
day of
A"EY L. DVPe E R
NOTARY PUBLIC,STATE OF NEW YORK
NO-0 1 DW6306900
ITHORI'ZAT11ON' '
PROPERTY OWNEIRAU
ner) jl!111�-IED IN S117-FOUK,COUNTY
EX,PIRES JUNEZ2
(Where the applicant is not the oW COMMISVON
residing at
to apply on
do hereby authorize
proval as described hereino,
Building Department for ap.-
my behalf to the Town of Southold
Date
owner's Signature
Print owner's Name
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in lop 11100'oft,
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