HomeMy WebLinkAbout47630-Z 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#: 47630 Date: 3/31/2022
Permission is hereby granted to:
Kovar. Rachel
�w. .. ._w_. . w..._._........_.__w w ............._..m_........ ............w __...........
...... _._._._.......
2375wwSi sbee Rd _
Mattituck NY1..x..9.52 _ w_............................_......._.....aaaa......._....... _.w.....
...ww.
To: construct accessory in-ground swimming pool as applied for.
At premises located at:
1295 Sisb ► Rd. Laurel
�....9_ . www_......maaa..... ..............-..�..........
_.............�w______.�..... _�__
SCTM # 473889
Sec/Block/Lot# 144.-2-5
Pursuant to application dated _ 3/1/2022 and approved by the Building Inspector.
To expire on 9/3012023.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Buil Inspector
,MwJ'IMY.rrteN' 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 Lt a5://WW"r.sOLltlioldtowtiii""L�-Y
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
E � fl
PERMIT NO, Building Inspector; ........
R- 12022
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 DEPT.
Owner's Authorization form(Page 2)shall be completed. SOWN OF SOUTHOLD
Date: 22_
OWNER(S)OF PROPS TY:
Name: SCTM#
1000- 144 _
Project Address:
Phone#: � . �' Email: PE�&V-G-Qml llyy
Mailing Address: "
CONTACT PERSON:
Name: R, T. i�
Mailing Address:
Phone#: 2 Email:
DESIGN PROFESSIONAL INFORMATION:
Name: �
Mailing Address;,
Phone#: P Email:
CONTRACTOR INFORMATION:
Nam
Mailing Address:
Phone#: I:Ej—"� ' 2�. " Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
[]New Struct e ❑A clition Alterati Repair ❑Demolition Este d 1.clf
Other A $
Will the lot be re-graded? Yes ❑No Will excess fill be removed from premises? Yes ONO
1
PROPERTY INFORMATION
Existing use of property: 0 y
Are there any covenants and restrictions with respect to
Zone or use district in which prpm Jr tuj ted: '
this property? Dyes V IF YES, PROVIDE A COPY,
p,,,eck Box After Reading: The owner/contractor/design professional is responsible for all dr4/1ge'a*"nd storm water issues as Provided by
ha� er 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, rt-nT e): OAUthorized A7�)Owner
Signature of Applicant: Date:
T A
440,01 W673165 7
OUAL011]�D 04
STATE OF NEW YORK) SUFFOLI(COUNrY :2
SS: Comm
1 s'2
COUNTY OF
N
0 F
P-.a rh-e2�I -k A -I AV— being duly hwqdriqi��ses and says that (s)he is the applicant
I t
(Name of individual signing conteract) above named,
(S)he is the 6)k)'YQ-4//'�
(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
/I I "t",
ni D��r , 20--l-4
-2;2�day of.
FNotary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
residing at
do hereby authorize W, to apply on
X",
my be to the n q outhold Build!pg Departp"Ifpf approval as describe erein
------------------
ner' ature -*NO,01 M1623165i... DOL,
V Ow S V i
:Z QUALIFIED IN
SUFFOLK COUNTY
W
Roe, �byd i:: . com
�r. 11-29.
Print Owner's Name
U80
......... A
OF N 0 �\�"
2
va 'Ot
'JA V 640102il 001 XdOA M3N
u'Aft
of Mow tf?)044 :Ogmol
je'l�
ado IyAjoj -,j
X0 P.1 U .1 ol/V
A-L6t2dOYd dO .4,gliung
$7144flteoevt *ova xj1piAl't Vw '/0 fy toj./ "Yo
v on%e /j>**
/I 'i 14 j Ww /o
VOW OJOYMY ol
�Y"OV& AMON, 'Sote �Ol�
A04 oftf
Y o.si
Ni
F,U, >' l7—
l ,�µ
1,44
1,64 -4
OVO4Y
:ql