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HomeMy WebLinkAbout53177-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#: 53177 Date: 08/05/2026 Permission is hereby granted to: Robert LaPoma 605 Leeward Dr Southold, NY 11971 To: install a generator as applied for. Premises Located at: 605 Leeward Dr, Southold, NY 11971 SCTM# 79.-7-26 Pursuant to application dated 07/20/2026 and approved by the Building Inspector. To expire on 08/04/2028. Contractors: Required Inspections: Fees: GENERATOR $125.00 CO- ESIDENTIAL $100.00 Total $225.00 _ � uilding Inspector�� �� TOWN OF SOUTHOLD— BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959 �1 � .�� Telephone (631) 765-1802 Fax (631) 765-9502 ht / dut .sottlo�dy awatta '.so�� Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only (C�', \vJ E PERMIT NO. Building In pector;._�,---L VC u Applications and forms must be filled out in their entirety. Incomplete jUL 2 0 2026 U applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. Building Departrnent TOWn of,outsold Date: � 2Q OWNER(S)OF iP_ caROPERTY: Name: 96 Lc.�c�J,t1,,A. SCTM # 1000- O`1 1— 00 " 0-1 — 00--O2 G AA Project Address: 60` ; lee c� �� ,,o�� N �' 1\ Phone#: (0 Email: �QblC' gip`^-a, cco"k, G °'�'1 Mail ingAddress: (00 5 \e&Jc• CONTACT PERSON: t Name: Mailing Address: \�-F2 ��,, \�yt� {i� jJy H—lol L Phone#: (03\-�24-\3C9� Email: C.DvVX DESIGN PROFESSIONAL INFORMATION: Name: N/ Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: Mailing Address: ,\-k �Jv�SR�t- V �""��' ,J�.!" aJy Phone#: �p �- ��-©— 1�v CO Email: °1 rt D fin ro'cl.Q i t (11, Com, DESCRIPTION OF PROPOSED CONSTRUCTION []New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: ®Other r �' 1'1. O� Will the lot be re-graded? ❑Yes Cho Will excess fill be removed from premises? ❑Yes [�o 1 PROPERTY INFORMATION Existing use of property: Intended use of property: Zone or use district in which premises is situated: Are there any covenant and restrictions with respect to this property? ❑Yes 1UNo IF YES, PROVIDE ACOPY. ❑ 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 th-e 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. �1 a Application Submitted By (print name): Ua,W� �f`4� Authorized Agent ❑Owner �" g pp .. Signature of Applicant: Date: STATE OF NEW YORK) COUNTY OF_5 j S L ) 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 f TT � z2aday of ZO 0b Notary Public SARPtNJA M PORN! "f`lry to+tlr,, twatf'Of Vew York PROPERTY OWNER AUTHORIZATION car.No i lags;,I eta County (Where the applicant is not the owner) Commission cxPOOS Dec,22, 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 Date Print Owner's Name 2 - -- SuFFmA co: ��APT.APPROY, . M.a NO. -22-5— vrrcrsr.^P} � �vacctnt� s. , NEAP Ow POOP61aZ'Y T lNTm �-- THE WATER SLY AND SEWAGE DISPC SYST04 FOR THIS RESIDENCE 1 {} aT CONFORM TO THE STANDARDS OF Ol �Pa4YLREYVn RIFOOLK CIO.DfPt.OF HEALTH SERYI IG14NT b.REEF. # ii�'C Su"OLK COUNTY D . 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