HomeMy WebLinkAbout48778-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
4 Fug
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 #: 48778 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:
860 Griffin St, Cutcho ue
SCTM #473889
Sec/Block/Lot# 102.-5-9.7
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
(L"
Building Inspector
of
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 htti2s://www.soullioldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only D ECE
PERMIT NO. Building Inspector: �,
'E 7,072
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an y NG
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TOMFSOMMM
Owners Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: -. ic:T
M#1000- Z rll [)-S—
-Pc-- l
Project Address:
Phone#: Email:
Mailing Address:
CONTACT PERSON:
Name: OL Ca
Mailing Address: 7 MAW °, A IT
Phone#• Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTORINFORMATION:
Name: _
Mailing Address: ��
Phone#:�� — ��tU L[Dk��- Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
E
El
Structure Addition ❑Alteration ❑ m
Re air ❑Deolitiorl E
stimated Cost of Project:
Other Adla I ir�w�
Will the lot be re-graded? ❑Yes PO Will excess fill be removed from premises? des ONO
1
PROPERTY INFORMATION
Existing use of property: ., , Intended use of property:
., LELLi
Zone or use district in which premises is situated: Are there any covena�No
and restrictio s with respect to
this property? ❑Yes IF YES,PROVIDE A COPY.
i
roTNI dal
N ew wri�d� *Won bsuate of a swidlog PwMit'Pufflu*too"sulmhu:
1000, of q
eilic, lerllptilieawmk rx� �r aaii ny i
l�a� is eiA raw p � i� �l c �Bd l� lie n�tCur mmserry PftV0% mode hemind are
agar rcrirftaw Pori ice,
fapfd ��
Application Submitted By(print n e) ° = �L� thorized Agent Downer
Signature of Applicant: Dates /I. -
STATE OF NEW YORK)
M.a e
SS:
COUNTY OF,50� I!
ate, '�e-rS being duly sworn deposes and says that(s)he as the applicant
(Name of individual signing contract)above named,
(S hh is the C90�4�c`(c 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 there . ,
sworn,he, me this BARBARA H. TANDNDY
Notary Nob101 TA60860 1e k
y 0(/�,. 20 n Suffolk Cou
L — � W or
� da of �I' Dual�fied I
Notary Public
(Where the applicant is not the owner)
I, "" -` residing at �
a LLC do hereby authorize =� C; to apply on
my behalf 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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