HomeMy WebLinkAbout53132-Z say 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#: 53132 Date: 07/16/2026
Permission is hereby granted to:
Edward M McGough
860 Jasmine Ln
Southold, NY 11971
To:
Legalize the installation of an HVAC system to an existing single-family dwelling as applied for per
manufacturers specifications.
Premises Located at:
860 Jasmine Ln,Southold, NY 11971
SCTM#69.-3-24.16
Pursuant to application dated 06/29/2026 and approved by the Building Inspector.
To expire on 07/15/2028.
Contractors:
Required Inspections:
Fees:
As Built HVAC $500.00
CO Single Family Dwelling-Addition/Alteration $100.00
Total $600.00
Building Inspector
s
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 htt)s://www.southoldtowim .aov
�"z " I
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only n
6
PERMIT NO. a_ Building Inspector
Applications and.forms must be filled out in their entirety:Incomplete J
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed. Oorp;
row
Date: jar ivary 12, 2026 n Of Southold
OWNER(S) OF PROPERTY:
Name: c scTM #1000- 69 - 3 - 24.16
Project Address: 860 Jasmine Lane, Southold, NY 11971
Phone#: 934 - 240 - 9319 Email: cmcgough8234@gmail.com
Mailing Address: 860 Jasmine Lane, Southold, NY 11971 LINDAB.SCHOLL
t New York
CONTACT"PERSON: ` • N�. -g1�5�25
Name: Steve Dalton Commission Expires May 5,20_
Mailing Address: 125 Lauman Lane, Hicksville, NY 11801
Phone#: 877-831-8333 1-Em—ail,�iSpatcher@slomins.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#, Email:
CONTRACTOR INFORMATION:
Name: Slomin's Inc.
Mailing Address: 125 Lauman Lane, Hicksville, NY 11801
Phone#:877-831-8333 Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration []Repair ❑Demolition Estimated Cost of Project;
Eil0ther Daikin Ductless Mini Split System (HVAC) $ 22,150.00
Will the lot be re-graded? ❑Yes ONo Will excess fill be removed from premises? ❑Yes ONo
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PROPERTY INFORMATION
Existing use of property: Single Family Residence Intended use of property: Single Family Residence
Zone or use district in which premises is situated„ Are there any covenants and restrictions with respect to
this property? ❑Yes �No IF YES, PROVIDE A COPY.
❑ 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): Steve Dalton (Slomin's Inc.) DAuthorized Agent ❑Owner
Signature of Applicant: Date: !/ 2/ /ZoZC�
STATE OF NEW YORK)
SS:
COUNTY OF
( /` being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contrac ) 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 T:T_Kj)arq
day of , 20_*
Notary'' ublic
LINDA B.SCHOLL
Notary Public,State of New York
PROPERTY O!AJNc_R AUTHORIZATION No.30-4858259
Qualified in Suffolk County
(Where the applicant is not the owner) Commission Exnires May 5, "
I, residing at 860 Jasmine Lane
Southold, NY 11971 Slomin's Inc. (Steve Dalton)
do hereby authorize to apply on
my behalf to the Town of Southold Buildlops Department for approval as describ d herein.
Owner's Signature Date
Print Owner's Name
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