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Home My WebLink About53199-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#: 53199 Date: 08/13/2026 Permission is hereby granted to: US Bank Trust National c/o Selene Finance LP Dallas, TX 75019 To: install central air conditioning to an existing single-family dwelling as applied for with flood permit. Premises Located at: 6900 Main Bayview Rd, Southold, NY 11971 SCTM# 78:6-9.4 Pursuant to application dated 07/30/2026 and approved by the Building Inspector. To expire on 08/12/2028. Contractors: Required Inspections: ELECTRICAL- ROUGH, PLUMBING , ELECTRICAL- FINAL, FINAL, Fees: HVAC $250.00 CO-RESIDENTIAL $100.00 lk", d Permit $150.00 Total 500.00 ---- BuNI`dir► Inspector -- Fn t 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 li�tti)s:�'e" w,,v. oLithr)ldto nn .izov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only 1 � (� � � �rr Building Ins ector: l `(( 4 PERMIT N0, g F� _ Applications and forms must be filled out in their entirety. Incomplete lil J U L 1? 0 026 applications will not be accepted. Where the Applicant is not the owner,an Owner's Authorization form(Page 2)shall be completed. auffrliinq. Department Town of SOUthold Date: 'Q21-�t�.2.ly OWNER(S)OF PROPERTY: Name: i'? t. SCTM # 1000- / 8 _ _ C" L w Project Address: 34 Phone#: o I' Email: MaiIingAddress: ��r I' C+t.W 06A J-')21V ')illJI1A-—'V260" rl CONTACT PERSON: Name: Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email. CQNI`RACTOR INFORMATK N: Name: —Ago6' j3ogtJS OmTRi 6 Mailing Address: `"7 � � �� ' 0 Phone#: �Z Email: C DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition eration ❑Repair ODemolition Estimated Cost of Project: ❑Other $ Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes ❑No 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? ❑Yes ONO IFYES, 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 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, 1 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 regulatirins 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): ' r" C'a+a.rn.i ❑Authorized Agent owner Signature of Applicant: 1 Date: -7 (- STATE OF NEW YORK) SS: COUNTY OF ) CAA 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, 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 ; day of , 20,jj� N tary Public 7RACEY L. WYER NOTARY PUBLIC,STATE OF NEW YORK PROPERTY OWNER AUTHORIZATION NO.01 DW6306900 01JALIPIED IN SUFFOLK COUNTY (Where the applicant is not the owner) CCHNW SION EXPIRES JUNEa0, b I residing at, g 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 ° tM BUILDING DEPARTMENT- Electrical Inspector TOWN OF SOUTHOLD Town Hall Annex - 54375 Main Road - PO Box 1179 4111-trvcn Southold, New York 11971-0959 46 Ilk ,�;:° Telephone (631) 765-1802 APPLICATION FOR ELECTRICAL INSPECTION ELECTRICIAN INFORMATION (All information Required) Date: Company Name: G .: Electrician's Name: 1 License No.: Re - '7 1 Elec. email: I Elec. Phone No: 431. ;.�-f�-?f ❑I request an email copy of Certificate o Compliance Elec. Address.: 62 JOB SITE INFORMATION (All Information Required) Name: ' ° " fA. Address: Cross Street: Phone No.: a- Bldg.Permit#: email: Tax Map District: 1000 Section: Block: Lot: q, BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly): 14b PI A16- /c;I,- Square Footage: Circle All That Apply: Is,job ready for inspection?: YES NO Rough In Final Do you need a Temp Certificate?: 11 YES NO Issued On Temp Information: (All information required) Service SizeF11 Ph F—]3 Ph Size: A # Meters Old Meter# ❑New Service❑Fire ReconnectOFlood Reconnect[Service Reconnect❑Underground Doverhead # Underground Laterals 1 2 H Frame M Pole Work done on Service? Y N Additional Information: PAYMENT DUE WITH APPLICATION 5UR.VEY OF PROPERT ' N 51TUAI"E: 5MTHOLD w 4 z"� TOM: 5OUT14OLD 5UFFOLK COUNTY, NY SURVEYED 09-20-0k,10-10-01 SUFFOLK COUNTY TAX# 7 J,,, 1000 f'76 6 H 4) �[y \�^y .CERTIFIED TO. Q DONNA GOOK • \ R /o y J ' 5 !,, , l "sue '�• 1 /, � �J Ir (}=1 �ry� �Jes `V 60 00. S C <7 NOTES I ,, .,..,.M.,"..,,,..�,., • ■ MONUMENT r o A STAKE ' n, fib, J1/ 5D2r „4i s u AREA - 20,896 5F OR 0.48 ACRES •• '^ 1 N5PEGTION AND EVIDENCE B 1V Y OTHERS JOH C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.N0.50202 GRAPHIC,5C,ALE "= 30' RIVERHEAD,N.Y.11901 369-8288 Fax 369-8287 REF.1\Hp server\d\PROS\01-171.pro