HomeMy WebLinkAbout47964-Z tc 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#: 47964 Date: 6/16/2022
Permission is hereby granted to:
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New WYork, NY 10016 _,_,_ww..
To: construct accessory in-ground swimming pool as applied for.
At premises located at:
415 Sixth Ave. Green ort
SCTM #473889
Sec/Block/Lot# 42.-1-9
Pursuant to application dated 5/17/2022 and approved by the Building Inspector.
To expire on _ww-12/16/2023.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Buildinj Inspector
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 htt� ://w w. o tl��ot ^r����..go�°
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
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PERMIT NO. � Building Inspector..............wwww ...............
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Applications and forms must be filled out in their entirety.Incomplete BUILDING DEPT
applications will not be accepted. Where the Applicant Is not the owner,an TOWN OF SOUTHOLD
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: V � � SCTM # 1000- +�.Z— !
Project Address: qp;r
Phone#: T� P- Email: rd--V Y
Mailing Address: wc L--;,, rV0 W 'AJ
CONTACT PERSON:
Name:
Mailing Address: �� . 7
Phone#: �� ) Email: A11A
DESIGN PROFESSIONAL INFORMATION:
Name: ' �...I,
Mailing Address:
Phone#: 1 ���_��� (o Email:
CONTRACTOR INFORMATION:
Name: -
MailingAddress: t Ilg7�
Phone#: .3f Email:
DESCRIPTIO OF PROPOSED CONSTRUCTION
❑New StructureAddition Alteration ❑Repair ❑Demolition Estimated Cost of Project:
C�'5ther iV " $ eav
Will the lot be re-graded? ❑Yes Will excess fill be removed from premises? C No
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