HomeMy WebLinkAbout46962-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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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 #: 46962 Date: 10/13/2021
Permission is hereby granted to:
Karagounis, Dennis
25 Arleigh Rd
Douglaston, NY 11363
To: construct accessory in-ground swimming pool as applied for.
At premises located at:
230 East Rd., Mattituck
SCTM #473889
Sec/Block/Lot# 106.-3-4
Pursuant to application dated 10/4/2021 and approved by the Building Inspector.
To expire on 4/14/2023.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Total: $300.00
t
Building Inspector
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 https://www.southoldtownny Dov
Date Received
APPLICATION FOR BUILDING PIERMIT
For Office Use Only {i €
PERMIT NO. 4Building Inspector
Li U NG r, PT
Applications and forms must be filled out in their entirety. Incomplete U°TOVVN0C 6�-
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date:SEPTEMBER 28, 2021
OWNER(S)OF PROPERTY:
Name:DENNIS KARAGOUNIS SCTM # 1000-106-03-04
i
Project Address:230 EST ROAD MATTITUCK NY 11952
Phone#:917-418-5883 Email: I
DENGOUN a�?AOL.COM
Mailing Address:25 ARLEIGH ROAD DOUGLASTON NY 11363
CONTACT PERSON:
Name:SAM E
Mailing Address:SAME
Phone#:SAME Email:
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DESIGN PROFESSIONAL INFORMATION:
Name:DENNIS KARAGOUNIS
Mailing Address:25 ARLEIGH ROAD DOUGLASTON NY 11363
Phone#:917-418-5883 Email:DENGOUN@AOL.COM
CONTRACTOR INFORMATION:
Name:DENNIS KARAGOUNIS
Mailing Address:25 ARLEIGH RD DOUGLATON NY 11363
Phone#:917-418-5883 Email:DENGOUN@AOL.COM
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
EilOther SWIMMING POOL $20,000.00
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? iiYes ONO
i
1
PROPERTY INFORMATION
Existing use of property: RESIDENTIAL Intended use of property:RESIDENTIAL
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
RESIDENTIAL this property? ❑Yes *No IF YES, PROVIDE A COPY.
lig 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(prXna ): N IS KARAGO D N I S C]Authorized Agent lROwner
Signature of Applicant: Date: 9-28,2020
STATE OF NEW YORK)
, SS: �'•
COUNTY OF J ®)
DENNISAGO D N I S being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the OW N E R
(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, _
Yl LUO
Noir Public,Stme of New York
Sworn e,ore me thi Registratf
No.OLU6365477 �
Quafinfiled in Nassau county
day o 20 Zll�
rr mis-sir moires iobs 2021 J
Notary Public
PROPERTY OWNER AUTHORIZA, N
(Where the applicant is not the owner)
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
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