HomeMy WebLinkAbout48777-Z TOWN OF SOUTHOLD
, BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
M , 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#: 48777 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:
720 Grilling St, Cutcho ue
SCTM # 473889
Sec/Block/Lot# 102.-5-9.8
Pursuant to application dated 12/14/2022 and approved by the Building Inspector.
To expire on 7/24/2024.
Fees:
CO - SWIMMING POOL $50.00
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
Total: $300.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 https:1/www.southoldtowLgty.go
Date Received
APPLICATION FOR BUILDING PERM,IT
or Office Use Only
PERMIT NO
Building InspeckarDEC"
n
DE1
Applications and forms must be filled out in their entirety.Incomplete BUILDING
applications will„not be accepted. Where the Applicant is not the owner,an TOWNOFSOUMV
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: =TM
1000-
Project Address:
Phone#: Email:
Mailing Address: l
CONTACT PERSON;
Name: ` ”' r
Mailing Address: '
Phone#: Email: t 1 t t ry .,.254)
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
act)
Phone#: nc
( ,S � ?,qP) Email. ,prt
DESCRIPTION OF PROPOSED CONSTRUCTION
Cher p ❑Demolition Estimated Cost of Project:
❑New Structure ❑A clition Alter tion ❑Reit a
Will the lot be re-graded? ❑Yes�N0 Will excess fill be removed from premises? kyes ONO
1
h. PROPERTY INFOR I " ON
Existing use of property: i Intended use of property:rL.,
-, Arb X
Zone or use district in which premises is situated: Are there any covenants and restrictiorls with respect to
this property? ❑Yes o IF VES,PROVIDE A COPY,
° a 'rhe ownap
� . #04slgn r Is res nelble for all d
po ralnaga and storm wafer Issues as provided by '
' i %ij/ f r i Tin � E m Bulldir�Department for the issuance of a Building Permit pursuant to the Building torte
�� i o i% ��/�a�f33 pk Suflb114 Cou1 I,New Park and other applkmble lean, a d6rwnoss or Regulations,for the consisuc0on of buldInm
�r�„ „� r loyal or dan►olkWn es herein described.74w applicant to comply with appBca6ls tows,onftnances,building code,
�! ,,, i w>uadto admit outhort<ed InspeoLors on premises pod M bnlldMg(s)for necessary inspections.False statements mode herein aro
P i71bsik$dps°a Si�pss'/mledemeanor pursuant to Section 210A5 ofthe New 7ork State Penal law.
Application Submitted By(print n e) Q ' µ1
.uthoriaed Agent ®®caner
Signature of Applicant: -
Date:
?
STATE OF NEW YORK)
SS:
COUNTY OF
beingdui sworn deposes and
says that
she is the applicant
(Name of Individual signing contract)above named,
(Sl19is 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 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&. .
cti.
Sworn before me this BARBARA H. TANDY
Notary Public, State Of New York
No. 01 TAB08600 f
30 day of Qualified In Suffolk County
Notary Public
,. .. PROPIVERTY OWNERkMGUM 00
(Where the applicant is not the owner)
I, a� " U'C residing at w�
do herebyauthorise � """� ddzC: to apply on
rri cif to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2
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