HomeMy WebLinkAbout48776-Z � t TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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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 #: 48776 Date: 1/23/2023
Permission is hereby granted to:
W andanch RE Cor
1325 Locust Ave
Bohemia, NY 11716
To` construct accessory in-ground swimming pool as applied for.
At premises located at:
560 Griffin St, Cutcho ue
SCTM # 473889
Sec/Block/Lot# 102.-5-9.9
Pursuant to application dated 12/14/2022 and approved by the Building Inspector,
To expire on 7/24/2024.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Total: $300.00
Building 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 littps://www.sotillioldtowmiy.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector:
1,"909
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an BUMNGIDEPT
Owner's Authorization form(Page 2)shall be completed. 7"OFSOUnm
Date;.
OWNER(S)OF PROPERTY:
Name: E � SCTM#++1000- 0Z
Project Address:
Phone#: Email:
Mailing Address: lur� t
CONTACT PERSON:
Name: �+ KT
Mailing Address: DD M&Irl
Phone#: ?J — Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
fMailing Address: 11 ��„� � -�..� t-
Phone + ( Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure []',Addition ,,❑Alter do Repair ❑Demglition Estimated Cost of Project:
Other
Will the lot be re-graded? ❑Yeso Will excess fill be removed from premises? es El No
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
'2IK
Zone or use district in which premises is situated: Are there any covenant and restrictio s with respect to
this property? Dyes o IF VES,PROVIDE A COPY.
PU gdi ,, Tim o� alb �
'P aiN
r i IN43 HOW if t*tl Sulld t a Qn of bu l ��O
M Zone
Varkand oftr,appRoble or ons,for ftt0r0xuctWft of bwmkqm
. ,,,,,, , naw wd d wNt i err mawwlwa ,rd is1,fw ilft r gMgry hopeoem W S*tWWft made hwvdn are
raw ml P xrwlsidsw raaw pwar puwl tO UWOK ZWAS of the New,yak* roe ps,"811"..
Application Submitted By(print n e) .�
*utharized Agent 130mer
Signature of Applicant: JAI") , r
Date.
STATE OF NEW YORK)
SS:
COUNTY OF )
being duly sworn, deposes and ( ) is thethat says (s)he applicant
(Name of individual signing contract)above named,
ohis the C&-R+ra�r
(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 therewithA. U402kL
BARBARA H.TANDY
Sworn before me this Notary Public,State Of New York
No. 01TA 088001
day of 20 a� Ouallfied In Suffolk C .My
ommi sion Expires 01:11
no
Notary Public
PR
�G � ' OWNE � � Q0 a m
(Where the applicant is not the owner)
- residing at ` : "'A M
do hereby authorize �� / to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
2
Print Owner's Name
2
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