HomeMy WebLinkAbout47472-Z r 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 #: 47472 Date: 2/22/2022
Permission is hereby granted to:
Sparacio, Sheri
330 Old Field Ct
.......... ......_.�__ ....ww_.._ ----- .....
Mattituck, NY 11952 ___________
To: Install in ground vinyl swimming pool at existing single family dwelling as applied for.
Minimum 15' setback from side and rear property lines required for pool and equipment.
At premises located at:.
330 Old Field Ct., Mattituck
SCTM # 473889
Sec/Block/Lot# 120.-3-8.26
Pursuant to application dated 1/27/2022 and approved by the Building Inspector.
To expire on 8/24/2023.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Total: $300.00
1111"N
Building Inspector
r TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. d. Box 1179 Southold,NY 11971-0959
�rAr Telephone (631) 765-1802 Fax (631) 765-9502 1 ¢1l
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Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use only
PERMIT NO. Building Inspector.
Applications and forms must be filled out in their entirety. Incomplete '
applications will not be accepted; Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed,
Date: - q-22
OWNER(S)OF PROPERTY: 2
Name: S,h-e--pZ `Jj !'�2� { l 5CTM # 1000-
Project Address: '330 OW R-eL-p - eN
Phone#: q(p�3 2, Email:
Mailing Address:
CONTACT PERSON:
Name: F - ` . .
Mailing Address: 4'2qpk-- 2w l0YC7�i�
Phone#: Email: O FVI C e 60,4e SIS,C'cm
DESIGN PROFESSIONAL INFORMATION:
Name..
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: p Pas
Mailing Address: 2Qi P--I- 2-5-4 14� Ga� 1110Y I -AW
Phone#: �,�.� _-� � — _ Email: � i('2�0 °�i7.}1S �C�t►'I
DESCRIPTION OF PROPOSED CONSTRUCTION
El New Structure ❑Addition _Alteration ❑Repair ❑Demolition Estimated Cost of Project:
E10ther _nn I V --
Will the lot be re-graded? ®-Yes El No JODL �1_ Will excess fill be removed from premises? Ayes ❑No
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Existing use of property: _gee,�@,Wca Intended use of pro ert
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑YesXNo IF YES, PROVIDE A COPY.
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Application Submitted By(print na e; C 1 ❑Authorized Agent Nwner
Signature of Applicant: Date:
STATE OF NEW YORK)
j SS:
COUNTY OF 6\JqS:&�z
Dl� 6PA-6-04 being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the ONPI-ef—
(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
Sworn before me this
day of ,
� �1JPt ........___.�.. 202 _ �
a_ 4&
MARGARE F A. KIDNEY
otary Public-State of New York
No. 01 K160211 11 AUTHORIZATION
Qualified.in Suffolk County PROPERTY OWNER
y Commission Expires March 8„2023 (Where the applicant is not the owner)
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
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SIZE . A B C D E F . G H AREA' ' CAP
FEET FT FT' Fl" 'FT' FT 'FT' .FT, ":FT .SQ.FT' -.GAL..
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631 7185 FAX (631) 744.0174
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24 X 44 24 44 18 14 A . :4 8 10 198351000 Suffolk_License: , 4436-HL:
24 X 48 24 48 20' '16 8 4 6, '.10 . 900 38;500 - Neissau._License. #M74450000 .