HomeMy WebLinkAbout48919-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERKS 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 #: 48919 Date: 2/15/2023
Permission is hereby granted to:
Esteves Hld Cor
80 Sunset Ave
Seldon, NY 11784
To: construct accessory in-ground swimming pool as applied for.
At premises located at:
465 Ripple Water Ln Southold
SCTM # 473889
Sec/B I oc k/Lot# 76.-1-15.5
Pursuant to application dated 2/2/2023 and approved by the Building Inspector,
To expire on 8/16/2024.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO - SWIMMING POOL $50.00
Total: $300.00
BuilMg 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) 765-95021tttg)s.�Hw�yNy.so tlioldtorNMU,M
N � ..M•
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only ell 9 I I
PERMIT NO. Building Inspector: 2,,� 0,
m
call
Applications and forms must be filled out in their entirety. Incomplete BULDMWK
applications will not be accepted. Where the Applicant is not the owner,an I�ailbrQY9 rf
Owner's Authorization form(Page 2)shall be completed.
i
Date;
OWNERS) dF PRO ERN:
Name: J A - SCTM# 1000-
w
Project Address: '
Phone#: _ Email ")caD '
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: Ell EE W lip-)V
Phone#: ' —:&j 02_. Email: 1 !
DESIGN PROFESSIONAL INFORMATION:
Name: 4
Mailing Address: (per
Phone#: /�{ Lp�4p .- Email M
CONTRACTOR INFORMATION:
Name: Px-kv&A I Vy) 0
Mailing Address:
Phone#: Q Email: ,.� f r ' : �.
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
ther
Will the lot be re-graded? Dyes2 '
Will excess fill be removed from premises? es ❑No
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covena 1Pand restHctions with respect to
this property? ❑Yes "o IF YES, PROVIDE A COPY.
❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage 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
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(p 'In 'dame): "t,thorized Agent ❑Owner
Signature of Applicant: alb. % rIr/IIS Oat .
STATE OF NEW YORK) `
:"coo.C2dI6 3
SS: GIJAIjjF, li C57:y
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"" :sE�lr ,
COUNTY OF ) Cd giC}6IITY
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being duly S V ( " ys that (s)he is the applicant
(Name of individual sign inontract) above named,
g
(S)he is the '4 a )'�
(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 therewith.
Sworn before me this
y of 20x3
otary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
? .
I, residing at
do hereby authorize ' ", to apply on
my behalf o the Town of S hold Building Department for approval as described herein." ":" �10'r,4
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Owner's Signature Date coert� r�, w
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Print Owner's Name
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