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HomeMy WebLinkAbout53175-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#: 53175 Date: 08/05/2026 Permission is hereby granted to: Frederick B Pollert PO BOX 578 Southold, NY 11971 To: install generator as applied for. Premises Located at: 375 Lighthouse Ln, Southold, NY 11971 SCTM# 70.-6-29.2 Pursuant to application dated 07/17/2026 and approved by the Building Inspector. To expire on 08/04/2028. Contractors: Required Inspections: Fees: GENERATOR $125.00 CO-RESIDENTIAL $100.00 Total $225.00 Building Inspector �� .i F+d 4 u. TOWN OF SOUTHOLD-BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 k� Telephone (631) 765-1802 Fax (631) 765-9502 ht� v.sotttholtitoNvnn-voov Date Received APPLICATION FOR BUILDING PERMIT ECE � VE 5 For Office Use Only PERMIT NO. Building Inspector„ J U L 17 2026 Applications and forms must be filled out in their entirety.Incomplete r iidin l T)IIn,rrf 'nt applications will not be accepted. Where the Applicant is not the owner,an °1'r vnn' of,k:;r��x`. r,,�ld Owner's Authorization form(Page 2)shall be completed. Date: / /`7 4,21 OO 6 OWNER(S)OF PROPERTY: Name: �L%bE2��ek �L u'ti)-/� jy t #1000- Project Address:5-7-r-�� 16�v>�JS r- 6q-X,)e- Phone#: 3i- 7 -f- F/OZ VA65/ 'r�5 ��° �"ail: cf3� �'4c" (7o I- ce'n Mailing Address: 6- 40 x 5 CONTACT PERSON: Name: 2�bE1� Mailing Address: /0010 /� �� >T 7� ✓ �� �y Phone Email:. E�r Q'oG G�.►-r DESIGN PROFESSIONAL INFORMATION: Name: C.oM~-j• /A 49-&- Idwww i- S t Tgws Mailing Address:2 5"" lf0'L4rSX1 Ny ! Phone#:0/--.1 kr'-- Email:r7.yri/O&L'-(P(`a c�.Wa vo��! I©wwoc7z COINTRACTOR INFORMATION: S`y'4.T�Ks •Cow Name: }. , Mailing Address: Phone#: Email: DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ORepair ❑Demolition Estimated Cost of Project ❑Other G FV&1- t/P G y qua-- /`(r 'Cloa, Will the lot be re-graded? ❑Yes [;�<O Will excess fill be removed from premises? ❑Yes,2NO 1 PROPERTY INFORMATION Existing use of property: intended use of property: Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? E]Yes E]No IF YES, PROVIDE A COPY. El 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 15 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): DAuthorized Agent C;iOwner Signature of Appl i Date: STATE OF NEW YORK) COUNTY OF Jiro being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the—*--(,.) (ContracGr, 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 -6, — '1'7 day of 20 (gary Public 0 T7ACOEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK PROPERTY OWNER AUTHORIZATION NO.01 DW6306900 OUIALIFIED IN SUFFOLK COUNTY (Where the applicant is not the owner) COMMISSION EXPIRES4JUNE 30,24,1� residing at .do hereby authorize a p p I y o n my behalf to the Town of Southold Building Department for approval as described herein. Owner's Signature Date Print Owner's Name L 2 --- ---- ................................................................................................................................. . .........'X 5UR\/EY OF PROPERTY 51TUATE: 5OUTHOLD N TOM: SOUTHOLD 9JFFOLK COUNTY, NY SURVEYED 05-11-2016 REVISED 04-05-2016 ALL SUFFOLK COUNTY TAX# 1000--70-6-29.2 '4'.eol CERTIFIED TO: FREDERIC,K FOLLERT 0 0 1 0 101-11 --4 asphalt driveway `oob lAc" 06'9so"Aj fW4 p , #40 pp —6 wlotjlk�t) f)r-0015F75 VM�021`6'AA- 711 NOTES: MONUMENT FOUND pi o AREA= 5G1,064 5G2 FT OR O.cfO ACRES 30, WETLAND IDENTIFEP EAGHARUS BUSH ELEVATIONS REF.NAVV 55 DATUM WETLAND FLA65 SET BY SURVEYOR ON DATE OF SURVEY of N "N. -=na R034 Ell 41111'11�117�11=1�1 JOHN C. EHLE AND SURVEYOR 6 PAST MAIN STREET N.Y.S.UC NO.50202 6RAPHIr- 5C.ALE 1 40' RVVERBEAD,N.Y.11901 369-8288 Fax 369-8287 REF.C.XUsmVohn\Dropbox\16116-133-field.pro ........................................ ---l---------� �-- i I