HomeMy WebLinkAbout47671-Z rr�a 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 #: 47671 Date: 4/12/2022
Permission is hereby granted to:
Suffolk County
._._... .. ._.__.____....._........_............_......_.._......................_.._.._... .._.._.._...............................w....wwwwwwwwwww.w_w.wwwwwwwww.�...ww
330 Center Dr
.....................
Riverhead, NY 11901_________________________________________________ww... w
To: construct accessory in-ground swimming pool as applied for.
At premises located at:
155 Broadwaters Rd, Cuitcho ue
SCTM...473889.. .._...._............
x�...___.........__.......
Sec/Block/Lot# 104.-12-8.1
Pursuant to application dated 3/14/2022 and approved by the Building Inspector.
To expire on 10/12/2023.
Fees:
-------------
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Total: $300.00
wilding Inspector
"Fc� t TOWN OF SOUTHOLD -BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971 0959
Telephone 631 765-1802 Fax 631 765-95021 tt Hww <u1h ldtowuy-m
Date Received
APPLICATIONI IIT
For Office Use Only E C
PERMIT N0. .... w wwwwBuilding Inspector:
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Applications and forms must be filled out in their'entirety.Incomplete:
applications will not be accepted. Where the Applicant is not the owner,an BUILDING S DEPT.
PP_ p PP TOWN OF SOUTHOLD
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
SCTM # 1000-
Name: �) t
mrAl
Project Address:
Phone#: ( Email:t�� 6
Mailing Address:
CONTACTPERSON:
Name: 6d-�Y�na ar 0�ul("I
Mailing Address:
Phone#(
Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:.
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address: p
Phone� p Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition 0-Alteration DRepair ❑Demolition Estimated C st of Project:
990ther 1M on $,
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises?>'es ❑No
1
PROPERTY INFORMATION
Existinguse of property: Intended use of ro ert :,
p p Y 1- p p Y aOX4D .i—
R'
Zone or use district in which premises is situated: Are there any coven nts and restrictions with respect to l
—qo this property? ❑Ye o IF YES, PROVIDE A COPY.
�,/ChBox After Reading:I The owner/contractor/design professional is responsible;for all drainage and storm water issues as provided by
eck
pir 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 hereindescribed.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 buildings)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): �nck m( rcu(I CJ tktorized Agent ❑Owner
Signature of Applicant: �&W&& Date: /w
STATE OF NEW YORK)
SS:
COUNTYOF `. ►� )
1 being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the In eja�
I�Eontractor,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 Ma ✓G. —, 20 2Z n�w-jvfvl /I A, I/
Notary Public
MICHELE A MEDUSKI
Notary Public,State of New York
F1 11:.:x' ,,,ry OWNER AUTHORIZATION Reg. No.01ME6393343
(Where the applicant is not the owner) Qualified in Suffolk County
Commission Expires June 17,2023
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
Buildin a Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
______ v_r...rr. residing at M mmmmmWmYmmmBroadwaters Rd, Cutchogue, NY 11935
Rahul Sharma & Veena Isaac 155
(Print property owner's name) (Mailing Address)
............................................................ do hereby authorize mm.._......... Katrina Mercurio _w. ......w ..._
(Agent)
_................................................................................................................ww. ww.wwww__wwwwwww_.................__
to apply on my behalf to the
Southold Building Department.
March 4, 2022
............................................. _.__._................. mm._.........._._....._......
(Owner's Signature) (Date)
Rahul Sharma
..... rvw(Print Owner's Name)
.......................................................
M
STREET ADDRESS,155 BROADWATERS ROAD HEALTH DEPT, REF, NO, R10-98-0037
N SURVEY OF PROPERTY
AT NASSAU POINT
TOWN OF SO UTHOLD
SUFFOLK COUNTY, NY
1000-104-12-8.1
SCALE: 1"=40'
DEC. 19, 2001
Odie"'. 26, 200t (prop, h .)
JA`, 14, 200 ( (k. fnd.)
APRIL 14, 200,3 (conc. fndtn.)
MARCH 17, 2004 (finol)
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ELLS FOR POOLS
TABLE WAT ET FROM ALL
m•.,., AREA=35,772 SF,
TO TIE LINE
urn forniliar with the STANDARDS FOR APt)ROVAL
AIV() CONSI t"6?tdCTIOV OF SURSUR ACTT S67 Alit,. LOT (H Flt'.'FLP 'rl) 'A EB `D MAP A, OF A ,AQ)
DISPOSAL OSAL SYS rEMS f Dl, SINGE F'-AMIL Y Rt.".5'IDM "ES POINT'FILED IN .P-,SIXFOLD COUNTY CLFRK 11"j7rr Ct`
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