HomeMy WebLinkAbout47286-Z at TOWN OF SOUTHOLD
� BUILDING DEPARTMENT
«� TOWN CLERK'S OFFICE
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 #: 47286 Date: 1/3/2022
Permission is hereby granted to:
O'Marra, John
12 Kent Ct _ ............ ..... _ ._ .. .. __..�....... .__....
w.__............... �...
Rockville Centre, NY 115704518
To: Construct accessory pool house and attached covered patio at existing single family
dwelling as applied for.
At premises located at:
935 Corey Gree Ln........ ..,
Creek LnSouthol.dw....... ................ ........._.�._.....____.�..,. .._.._� .. ..
SCTM # 473889
Sec/Block/Lot# 78.-4-22
Pursuant to application dated8/23/2021 and approved by the Building Inspector.
To expire on __ 7/5/2023.
Fees:
ACCESSORY $391.20
CO-ACCESSORY BUILDING $50.00
Total: $441.20
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 I lg FIaaliI�iapµ rr �, „ ,� „
Date Received
APPLICATION IL PERMIT
u
For Office Use Only """�"`” N "�000 �� Y \Y I
PERMIT NO.
r Building Inspector:.--.- Q
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant Is not the owner,an til 1 "N G D I°2'T
Owner's Authorization form(Page 2)shall be completed.
° OF m i„ i,
Date:
OWNERS)OF PROPERTY:
Name ' I� c' SCTM # 1000- ^
�..�
Project Address: t "
j ...° r1
Phone#: (P q (� Email• ,
Mailing Address: a � �' yr a �r � �� 71
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CONTACT PERSON:
....._.. ._.. _.www_. �. .. ..._
Name-
Mailing
ame:
Mar in
�°.......... ��...
g Address: `f
Phone#: G, b Email i gq
DESIGN PROFESSIONAL INFORMATIO1:
Name �.
Mailing Address: . . ,C -D A P1-1 :.
iVA t4 1
Phone#: EmaiJy-
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project
❑Other
Will the lot be re-graded? ❑Yes '/N Will excess fill be removed from emises? es ElNo
OPI1
PROPERTY INFORMATION
Existing use of property: L - Intended use of property: �, tt J �O bq
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ElYes UNo IF YES,PROVIDE A COPY.
Check Box After h Reading: 11ie own r/contractor/desltn al is for all elrainage and storm water issues as provkted Isy
Chapter 236 of the Town Code. '1710N 15 HMSY MADE to the Bulkling Department for the issuance of a Building Permit pursuant to the Bule3ing Zone
CHInance of the Town of Southold,Suffolk,County,New York and otherapplicable Laws,ordinances or RegWaSons,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,bulkling code,
housing code and regulations and to admit authorized Inspectors on premises and M bupdingls)for necessary Inspections.False statements made herein are
punishable as a class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
Application Submitted By(print name): Xe Jel m�f I1dAuthorized Agent ❑Owner
`�'
Signature of Applicant Date:
STATE OF NEW YORK)
SS:
COUNTY OFh, ll )
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the
µ � f 7,
(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
NATALIE LOPEZ_ atary Pu
NOTARY PUBLIC.STATE OF NEW YORK
Registratio .oro.01i,06202206
Qualified is Nassau County 1' P' NEI I� I I
�. ��p_... arch 9 �ll� IS 1101 the Owner
Comnussion Expires M )
(Where the applicante
. .,,
f
.. g aFC
residin at
d
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as scribed herein.
ttf Me
Print Owner's Name
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KENNETH WO Y( H(!
S UI F(":I .VA C;G:)U"d I '(, Cd1.:1111 ('h)IlK Professional land
P.O. Box 153 Aquet
' 19 ;CM; I"—.50' I)A% )I I'I. 1 ")019
PHONE; (631)298 15811
NAS. L/SC NO. 050882 maintaining the records of RobE