HomeMy WebLinkAbout48730-Z r TOWN OF SOUTHOLD
� s 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 #: 48730 Date: 1/12/2023
Permission is hereby granted to:
Burke, Robert
85 Leeward Dr .. ee .. .r. .. _—_-------
Southold, NY 1. -. .. ��..�_ .�......� .m �
1971
To: Construct an inground swimming pool at an existing single family dwelling as applied
for. Pool and pool equipment must have a minimum setback of 15 feet.
At premises located at:
85Leeward Dr Southold
CTM #473889
Sec/Block/Lot# 79.-7-32
Pursuant to application dated 11/17/2022
and approved by the Building Inspector.
To expire on 7/13/2024.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
Building Inspector
e .,.
� � 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) 765-9502littl)s://www.sotittioldto,wnily.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only � i G
PERMIT NO. ;J (`J Building Inspector.
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. �,'�, t",�".°`O� . : ..
Dater
OWNER(S)OF P OPERTY:
4-1
Name: T SCTM#1000- —7 - -32,
Project Address. ry � -
'0' y s�b 0
Phone#: q '7
w— ��� Email �J t
Mailing Address;
CONTACT PERSON:
Name:
Mailing Address:
...
V4—
Phone#:� � �` Email: kAd 0
DESIGN PROFESSIONAL INFORMATION:
Name n
1 ,.
Mailing Address:
Phone#: _ Email: y
CONTRACTOR INFORMATION:
Name.: Cl �
Mailing Address:
Phone#: .,, Email: J2 WV Wil, K ,
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Esti ated Cost of Pict:
Other $
Will the lot be re-graded? ❑Yes " ''bio Will excess fill be removed from premises? s ❑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 arAd restrictions with respect to
this property? ❑Yes ❑ IF YES, PROVIDE A COPY.
❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drains a 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
l
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted BY(pp nt n e): A 'thorized Agent ¢ ner
Signature of Applicant: D e ( J�
STATE OF NEW YORK
SS:
COUNTY OF )
IL-ILL_�7 " being duly sworn, deposes and says that(s)he is the applicant
(Name of indivi u I sign
ing
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 applicatiol, g"tNe4q,the best of his/her knowledge and belief; and
that the work will be performed in the manner set forth "' M �t-Ap� i file therewith.
6 5
Sworn before me this No.W IFIED IN
oii�ai.�rii.i.� gra
SUrF011KCO U,NTY
comMe
day of Iyy v 2 �
r' .. ,Uet��• '" Votary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, l�l� K— residingat L'ena4-
i,,�, Lim
w
.f7 �do hereby authorize . : ' o apply on
myb h to e Town of Southold Building Department for approval as described herein.
Owner's Signature "
eV D to
fC
Print Owner's Name sUrF01 K COUNTY "
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