HomeMy WebLinkAbout48966-Z TOWN OF SOUTHOLD
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#: 48966 Date: 2/27/2023
Permission is hereby granted to:
Kelly, Kevin
42 Oxford Rd
Manhasset, NY 11030
To: construct accessory pool pavilion as applied for. Must maintain minimum 5' setbacks
from lot lines.
At premises located at:
295 Fanning Rd
SCTM #473889
Sec/Block/Lot# 117.4-10
Pursuant to application dated 2/21/2023 and approved by the Building Inspector..
To expire on 8/28/2024.
Fees:
ACCESSORY $178.00
CO-ACCESSORY BUILDING $50.00
Total: $228.00
Building Inspector
11;41.
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 htt12
s://www.southo)dtow y gov
r
.sr.mas''
Date Received
APPLICATION FOR BUILDING PERMIT
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For Office Use Only M w0 nil ;
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PERMIT N0. Building Inspector:ector:
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FIER 91 10o I
Applications and forms must be filled out in their entirety.Incomplete BUIWINU
applications will not be accepted. Where the Applicant is not the owner,an TOWNCIFSOUTHM
Owner's Authorization form(Page 2)shall be completed.
Date: r Z\ 2�z�
OWNER(S)OF PROPERTY:
Name: K V—. , i I �<0\ SCTM#1000-
Project ,. c:.. . . , .
PrajectAddress: � q r � �� � S k
Phone#: 6 Ica Email: k/ <e c'
Mailing Address: y p� ,—� � Gy( t �lJ )/,D .3
CONTACT PERSON:
Name: K':.s
Mailing Address:
Phone#: (� —�� ) — �Jb3 Email: K1Ce1 15500 ��, ,�,c � 'I T--
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address: 'P'o
Phone#: �;3 _ 9 L S Email: ro �e
CONTRACTOR INFORMATION: u
Name:
Mailing Address:
Phone#: s Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Additio ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
',.Other Pc°,.l�i'�ot- I I , $j�,c�C.)
Will the lot be re-graded? ❑Yes�4No Will excess fill be removed from premises? Yes
1
PROPERTY INFORMATION
Existing use of property: tree Intended use of property: .4ov—, e,
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property" ❑Yes VNlo IF YES, PROVIDE A COPY.
heck 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 15 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 buildings)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(print name : `�' ❑Authorized Agent 90wrier
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF
4
4<C ,4 I E being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contracA 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 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
21,0
day of 20 23
otary Public
DIANE DISALVO
NOTARY PUBLIC-STATE OF NEW YORK
No. O1 D1475593 PROPERTY OWNER AUTHORIZATION
Qualified in Suffolk County (Where the applicant is not the owner)
MY Commission Expires April 30, 20Z(p
residing at
do herebyauthorize
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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GUARANTEED TO:
I' - x`" ''��'`'-- � 1 1•. KEVIN KELLY AND RRICID GILLESPIE
`�3 I I= i L��i lt'N NfG NA710NAL TME INSURANCE COMPANY
TRADITION TITLE AGENCY,INC
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LOT AREA €l , §[ 73f}1D IA€;
T£.= 16,500.30 S.F. ANNING RDF.=0.38 AC. i 1 fq€7f1� 1Je`�fpet:1�?517 dY-, � �- Ilt I t
- 16,500.30 S.F. 8,263.80 S.F CLEARED `>' €;/tl/a7't 7a 0'171'13 6L'iV€y _ Ile
0.38 AC. 509 LOT CLEARED (FlSHLR ROAD) �� _ _ ?`
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ON4YTAX MAP NO.
1000-117130-011-00-010000SURVEY OF PROPERTY
295 FANNING ROAD
-.- C - JOB No.S18-0128
SITUATE
NEW SUFFOLK, TOWN OF SOUTHOLD
a n d surveying DATE SURVEYED: 02/14/2016 SUFFOLK COUNTY, NEW YORK
sl mjslandsurvey com ,100
P 631957 2Y RMC CREW AL SCALE 1 20