HomeMy WebLinkAbout49032-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#: 49032 Date: 3/15/2023
Permission is hereby granted to:
Douglass, James
735 Ma'ors Pond Path
Orient, NY 11957
To: construct accessory in-ground swimming pool as applied for..
At premises located at:
735 Majors Pond Path, Orient
SCTM # 473889
Sec/Block/Lot# 26.-2-39.14
Pursuant to application dated 2/6/2023 and approved by the Building Inspector.
To expire on 9/13/2024.
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
m^° Telephone (631) 765-1802 Fax (631) 765-9502 littp ://",w v t tliol(I oNvi�[�.,
Date Received
APPLICATION FOR BUILDUINGPERMIT
For Office Use Only
lU IC II QUI
PERMIT NO. Building Inspector:
FFR 0 6 2023
ID
Applications and forms must bulled out I�their entirety Incompletd BUOLIANU DEPS:
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applications,will not be acts t d/mere the A�plkant�s pother,a
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Owner's,AuthorizAP!o�farm�� o'Z)Sh�1)�21C�R1F11d</ /%G %ii/ r jra%f/ /
Date:
OWNERS)OF PROPERTY ,// ;r',�/' % '� 1��/;rr /
<, , i /, /J,/i/viii%�%%/ i % ���/,��
Les
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Name: i Les SCTM # 1000- — �— 'Sq
Project Address mm
Phone#: 4 a -91461/1-7- . - IO Email:
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Mailing Address:
CC►NTACT P]EtISO1V.
Name: L-) ,. ' 0
Mailing Address: `) S 000—K .
Phone#: O _ Emai111tl•
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DESIGN PROFESStONAL �,O/R �/ /
Name:
Mailing Address:
Phone#: Email:
�,fi /idy 3f / it i77,77,r, 777'7177�7777
CONTRACTOR fNFORMA"TlON
Name:
Mailing Address: ,
Phone#: Email•
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DESGRIPTI,ON QI:PRQ/!C S I�% j�T ) ?�Ir
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of "roject:
Other 5�zm t , $
Will the lot be re-graded? ❑YesIN0 Will excess fill be removed from premises? Ayes ❑No
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Cv.rnsL °t � a� ak
Existing use of property, Intended use of property:
11%nq wlauvLwfro"
Zone or use district in which premises is ' uated: Are there any covenants nd restrictions with respect toy
1\^ this property? ❑Yes' &Uo IF YES, PROVIDE A COPY.
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Chf,.,!ck Box Aft6r, R p id � ,/� eo�er �,y �f ip� ° f7sr � �y;{' 'ar 11,�1raina a rfdstb a} rissuesas; rovidedb
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Chapter 236 of the Town Code, APPUCAT14N tS Hf:IEB�IiIVf/i�E tp �i�6(jiprt�r��n�farMfe is��farfce/ /�ywfldln�Permit pu uant to the Building Zone
Ordinance of the T)own of So4tt
in
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it
additions,alterations or;for rem' alarr lr,r,,
d"'
housing code and re a ations and to adh x /� ��a sr rt n I f F � r, er�tf m d Ce► -:are
,i /r rl�.✓7l J �U//Oi//ir6/i/ /. / �i %/i./ li ��� /iii !,,D 1 i ,✓r / ///il i//iia r /�„l�T ,, ..:
punishable as a Gass A;mrsdemeanar purruars S%1jn � /ffe YarI�S tc�;,�riat /// //
Application Submitted By(print name): *uthorized Agent ❑Owner
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Signature of Applicant: Date: aj(,p/13
g
STATE OF NEW YORK)
SS:
COUNTY OF
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the 7
(ContActor, 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
ml day of - 20 a3
Notary Public
MICHELE A MEDUSKI
PROPERT
.. OWNER . l„W)""�. O�RI "I..III Notary Public,State of New York
M.. M.M. _ _............. .- Reg, No,01ME6393343
(Where the applicant is not the owner) Qualrfied in Suffolk County
Commission Expires June 17,2023
N, residing at
do hereby authorize 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
X_.'...
ussell �
c �T
SUPE � � I��][A1�A�G�]EI��1[]E1�
m:� « a �, HALL-P.O.Box 1179
[TT�•COLD,NE'WYORK 11971 °�, - Town of Southold
- i " x = �~
CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM
(APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT
ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. )
APPLICANT: (Property Owner, Design Professiona1,C41g,en Contractor, Other)
NAME: p �"4
Date:
C;N
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mr ..
Contact Information:
IE-Mad&Telephone Number!
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Pro.ert Address / Location of Construction Site:
S.C.T.M. #: District000
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Section Block Lot
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TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT
Areaof Disturbance is less than I Acre. No S P.D.E.S. Permit is Rea h-ed h �
Project does Not Discharge to Waters of the State. Cho SYES
.D. . . P rma R aired 1
4A
- Area of Disturbance is Greater than 1 Adre & Storm-water Runoff Discharges Directly
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to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit L
DIRECTLY From N Y.S. D.E.C. Prior to Issuance of a Buildin Permit.
Area of Disturbance is Greater than 1 Acre& Storm-water Runoff Flows Through Southold
❑ Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN
a. S.P.D.E.S Permit through the Southohd"Town En ineering De artrn
Prior taa Issuance of a Iuilrtin Permit, ;I
Rpvie�ved By: Date:
Pnrz nn # qM(.. r(Vrr)t,Pr ?n i 4
Buildine De artsment Application
AUTHORIZATION
(Where the Applicant is not the Owner)
(�es�lF oc
residing at
(Print property owner's name) (Mailing Address)
�..�.. .� . G..,,.�....,do hereby authorize
(Agent)
to apply on my behalf to the
Southold Building Department.
( ° graature) (Date)
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_� ...w .... �cc 1_�... ..._.
(Print Owner's Name)
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