HomeMy WebLinkAbout47597-Z TOWN OF SOUTHOLD
rte ' BUILDING DEPARTMENT
P 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 #: 47597 Date: 3/24/2022
Permission is hereby granted to:
Borkowski, Joan
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PO BOX 122
------ .......................
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New Suffolk, NY 11956
To: Construct in-ground vinyl swimming pool at existing single family dwelling as applied
for.
Minimum 10 foot setback from property lines required for pool and equipment.
At premises located at:
4520 New Suffolk Rd New Suffolk
SCTM # 473889
Sec/Block/Lot# 110.-8-28.1
Pursuant to application dated 2/24/2022 and approved by the Building Inspector.
To expire on 9/23/2023.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Total: ��� � $300.00
Building Inspector
TOWN OF SOUTHOLD —BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 lttp»�� wr antlt ( t ,¢1c
Date Received
APPLICATION FOR BUILDING IT
For Office Use Only
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PERMIT N0. � mm _ Building Inspector... www_.m_M_......._.. ....._.._.......
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: � j Z
OWNER(S)OF PROPERTY:
Name: 104-76- TSCTM# 1000- ��� _ _ 2 -
Project Address: '16 2-o
Phone#• Email:.
Mailing Address:
CONTACT PERSON:
Name: -�Q.Sw7 4e
Mailing Address: 9.700 ,ti!alh c � "1} s T i //qS Z
Phone#: �� ZgZ5 - %G/L/ Email: Z-r 60/00,4A Lof10� C-.!a vr-•C.0 °
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name; Gr i!A o (3�n t,
Mailing Address:
Phone#: 2-91 �/7/Gl Email: 5-P, �� �O�' %G� l OD/ccI C
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
%Otherm /n54,--u l/!hc / 1 C� ( $
Will the lot be re-graded? ❑Yes *No Will excess fill be removed from premises? 6yes El No
1
PROPERTY INFORMATION
Existing use of property: p , 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 Ao IF YES, PROVIDE A COPY.
Chapter�23�6 0 x I orm . The owner/contractor/design professional is responsible for all drainage and stone water issues as provided by
f the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Bullding Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,OrdinarKes or Regulations,for the construction of buiklings,
additions,alterations or for removal or demolition as herein described.The applitam agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and in buildings)far necessary,inspectlons.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 220AS of the New York State an Law.
Application Submitted By(print name): ,C E. iLc75 WAuthorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY
o
r
being duly sworn, deposes and says that (s)he is the applicant
(Name of i dividua'l 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
°Z 3 day of �UU- 0,n 20 o"L
otary Pub '
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P Q[)^ EC" 1.Y,. µ ..,..OWNER AU FlIQRIZATIOIY ALEXUSABIRKMIER
Notary Public-State of New York
(Where the applicant is not the owner) NO.01BI6415618
QualifiQd in Suffolk County
y sloe Expires Mar 22, 2025
d �
M Commission
residing at
IC- do hereby authorize + rr � �_ to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature IDate
Alt-[WL"-c' PLC-r—A1ph1L
Print Owner's Name
2
ff BUILDING DEPARTMENT- Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
7 "p° Telephone (631) 765-1802 - FAX (631) 765-9502
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APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date: Z Z 2® -yz
Company Name:
E'lectrician's Name: _ -, � IwiCc�C�
License No.: Elec. email'.
Elec. Phone No: 34/3 2..❑I request an email copy of Certificate of Compliance
Elec. Address.:
JOB SITE INFORMATION (All Information Required)
Name: I e , rcri.�
Address: //S2(5 .,QeW
Cross Street:
Phone No.: 412-
Bldg.Permit #: email:
Tax Map District: 1000 Section: //0 Block: a Lot: 2-8, !
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly).
suWy �z� �,°� -I-b Cool-) 7- G I,- �
Square Foota e:
Circle All That Apply:
Is job ready for inspection?: YES ® NO F-1 Rough In Final
Do you need a Temp Certificate?: F*� YES ® NO Issued On
Temp Information: (All information required)
Service Size 0I Ph[]3 Ph Size: A # Meters Old Meter#
❑New service[]Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 D2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION
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SUFFOLK COUNTY,
N/0/P ROSEANN BURNS 1000-110-06-28.1
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700 Main Road
p Mattituck,NY 11952
Office:631-298-4014
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Info@NorthForkPoolCare.com
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Pool Walls are 10"thick at a height of 48" (Four Feet)
Walls are formed and poured with 3500 PSI Gravel Mix Concrete
- #3 Rebar is placed inside the wall. Horizontally (doubled) at the top and
bottom of the wall. Also,vertically every four feet at maximum.
• • - A sand bottom is installed for pool floor. A vinyl liner is installed on top
of sand and concrete.
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