HomeMy WebLinkAbout47355-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
y $ ' TOWN CLERK'S OFFICE
"oy • SOUTHOLD, NY
0
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#: 47355 Date: 1/19/2022
Permission is hereby granted to:
Pappas, Teddy
545 Breakwater Rd
Mattituck, NY 11952
To: Remove above ground swimming pool at existing single family dwelling as applied for.
At premises located at:
545 Breakwater Rd, Mattituck
SCTM #473889
Sec/Block/Lot# 113.-3-6
Pursuant to application dated 12/27/2021 and approved by the Building Inspector.
To expire on 7/21/2023.
Fees:
DEMOLITION $100.00
Total: $100.00
Building Inspector
o�osofFac r�o TOWN OF SOUTHOLD—BUILDING DEPARTMENT
in x Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
oy�91 a�l� Telephone (631) 765-1802 Fax (631) 765-9502 htti)s://www.southoldtownny.aov
Zec, 100-7q I /0V 1 11?q
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
rF PERMIT NO. 6�75 � r Building Inspector: `'� E Fr
® r
Applications and forms must be filled out in their entirety. Incomplete (� DEC 2) T 20121
applications will not be accepted. Where the Applicant is not the owner,an }
Owner's Authorization form(Page 2)shall be completed.
Date: CJ
OWNER(S) OF PROPERTY:
Name: 7i;Q A �'
T�-C
TM #1000-
Project Address _q 5 kr7qac 6/ - �a AQ I"A —7 rc-- e?52- .
Phone#: �L�_ Email:
Mailing Address:
CONTACT PERSON: Q[�
Name: 7� '/-
Mailing Address:,57u 5-
/ '
�j.
Phone#: f �L� Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair emolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes ❑No 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 ❑No IF YES, PROVIDE A COPY.
❑ 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(print name): ❑Authorized Agent El Owner
Signature of Applicant: Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01BU6185050
SS: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14,2s1�j
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
,, �
al`''►+�day of �C�icilf�,� 20A I
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, -�00-/ residing at 5 /�Au a0IA 76P RIO #?A%�/7w
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
APPROVED AS NOTED
DATE:. ' ��' B.P.# /-73$E_
FEE:4�8 10V,V�D BY:
NOTIFY BUILDING DEPARTMENT AT
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECTIONS: ;_'.
1. FOUNDATION -.TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH FRAMING & PLUMBING
3. INSULATION
4. FINAL- CONSTRUCTION MUST
BE COMPLETE FOR C.O.
ALL CONSTRUCTION SHALL MEET THE
REQUIREMENTS OF THE CODES-OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
COMPLY WITH ALL CODES OF
NEW YORK STATE & TOWN C ODES
AS REQUIRE AND C0NQ;ITIONS OF
SOUTHOLD 71,11NZAA
SOUTHOLD TOWN EiNING BOARD
SOUTHOLD TOWN TA -0
N.Y.S.DEC
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