HomeMy WebLinkAbout49112-Z TOWN OF SOUTHOLD
°�raBUILDING DEPARTMENT
I TOWN CLERK'S OFFICE
�1.1 ;`
al 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 #: 49112 Date: 4/11/2023
Permission is hereby granted to-
King,Kng, Daren
1330 Factory Ave
Matti _...... ........ ^_ _._..... ......�.
........... tuck, NY 11952 m mm _ .... ....._
To: Construct an in-ground swimming pool to an existing single family dwelling as applied
for. Pool and pool equipment must maintain a minimum setback of 5 feet.
At premises located at:
1515 Sigsbee mRd, Laurel
SCTM # 473889
Sec/Block/Lot# 144.-2-10
Pursuant to application dated 3/10/2023 and approved by the Building Inspector,
mm
To expire on 10/10/2024 „
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Total: $300.00
_._..._------....... _.... _._ ._... ... A.
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
*0 Telephone (631) 765-1802 Fax (631) 765-9502 https,1/www. oulholdtow yn . -ov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
MAR 1
PERMIT NO. Building Inspector:
'
Applications and forms must be filled out in their entirety.. Incomplete a'OViPN OF 1-1,01��g C.4€S'uj
applications wlll not be acepfed INhere'the Applicant is not the owner,an
i. „ Y,
Ouvnar'S'Au*6"' ion;fof�m,�0&2)shall be completed.
Date: � C>
OWNERS)OF PROPERTY:
Name , SCTM#1000-
r
— El mgko
Project Address: '
[„. _/
Phone#: Email:
- I r?qpo .,- / t 0 Me. , .
Mailing Address: 15 / \S-(g sbe�c kc( M /�'Uc d, C
CONTACTPERSON:
Name;
. 0 f�
Mailing Address:
Phone#: �"� ,_ �"
Email: � I f� C7 "" -.in Cj,)22
DESIGN,PROFESSIONAL INFORMATION: .
Name: Poo
� "'' I sbeazl i'ii
."
Mailing Address: )
Rhone#:
Email:
CONTRACTOR IMAT
NFORION;'
Name: "
Mailing Address:
a
Phone#: ....,, Email:
DESCRIPTION OF PR0� "06 ED CONSTRUCTION
,'New Structure ❑Addition ❑Alteration ❑ pRe air ❑Demolition Estimated Cost of Project:
Other �� $
Will the lot be re-graded? es [:]No Will excess fill be removed from premises? Yes ❑No
1
��
PROPERTY INFORMATION"
Existing use of property: ,� Intended use of property:
1t�.t'. `
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes l�N° IF YES, PROVIDE A COPY,
g ec BOX After Reading, 1Me owners writ for design orol ssional is resp �hI for all draoa ,e nod stoor1 w ter Issued 064144 by
�pter of the Town drde, APPL(� I NIS HF 8�Y pe to the soil ing100poxtIrRen f issuance of a 1 mildingPermit pursvant koffha l�pQg1n, Zone
Ordinance It rat ons or f s removal u' delmol6 nfy,New York and
In described.
applicable Laws,Ordinances or itegulatrons,,for the constructlon of buildings,
d.Thea ' licant a reel to com ° "
pp g ply Mrltti all e�ipifcable laws,ordinances,building code,
housing code and regulations and to admit authorised inspectors on premises and In building(s)for necessary lnspcctions.false stater*' > 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)t � "i;t > w,ni j ❑Authorized Agent '❑towner
,.w" � . ��
Signature of Applicant: Date"' � / c tt-
STATE OF NEW YORK)
SS:
COUNTY OF 5 ,
I
being duly sworn, deposes and says that (s)he is the applicant
(Name of)individual signing c ntract) above named,
. f..
(S)he is the Y _ ....�
it b ' s
(Contractor, Age nt;'Ct porate Officer, etc.)
of said owner or owners, and is duly authorized to perforrl"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
19
day of � ��✓' ��"���^
....
mm, zo ,,.,
M„M No Public, le of New Nlr , 'b I i xrri0i&rusgl
NOTARY ` �' W YOSIi
No.01OR6280392
PWuc
ual liod in siffoll.cowty
PROPERTY OWNIER AUTHORS T14� r� M;p��,w�'' CMIMiSlonhpi 05/13l200�1
(Where the applicant is not the owner)
residing at C A, d,
�. do hereby authorize I
�� {-J'��'..?�`�_ "� 1 to apply on
my behalf to the Town of Southold Building Department for approval as described herein..
caner"s Signature
Date
Print Owner's Name
2
unty Dept of
o isomer Affairs
HOME MWROVDOENT LICENSE
MICHAEL A OEWNKA
Elusmess Name
This cortities that the
bearer is duly licensed POOL TIME IN THE HA PTO 3 INC
by the County of suffoik
License Num,bar-.H-25569
Rosalie Drago Issued: 08128/1997
Commissioner 08101/2023
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