HomeMy WebLinkAbout49204-Z : $ TOWN OF SOUTHOLD
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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 #: 49204 Date: 5/3/2023
Permission is hereby granted to:
Bonilla, Edwin
82-44 218th St
Queens Villa a NY 11427
To: construct accessory in-ground swimming pool as applied for.
At premises located at:
70 Gillette Dr East Marion
SCTM # 473889
Sec/Block/Lot# 38.-2-1
Pursuant to application dated 4/4/2023 and approved by the Building Inspector.
To expire on 11/1/2024.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $250.00
CO- SWIMMING POOL $50.00
Tidal: $300.00
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Building 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) 765-9502 ( ttnWwww. out(iol'.dtOw1L oy
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
u
PERMIT NO. Building Inspector:_
pp APR 0 3 2023
Applications and forms must be filled out in their entirety. Incomplete
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applications will not be accepted. Where the Applicant is not the owner,an ��'Idii'� �pu i" ,
Owner's Authorization form(Page 2)shall be completed.
Dat
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OWNER(S)OF PROPERTY:
Name: SCTM#1000- �a—
Project Address:
Phone#: /gyp Email: '®V) ,
Mailing Address: D 6 //Vttot df, N14-11 64n
CONTACT PERSON:
Name:
Mailing Address:
I/ P VV'
Phone#: - Email:
53
J 02 e-)Uelo�A�) )Q rV A
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address: �
Phone#: � � � Email:
DESCRIPTION OF PROPOSED CONSTRUCTION ,
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Esti d Cost of Praj
er
Will the lot be re-graded? ❑Yes No 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 is and restrictions with respect to
this property? ❑Yes IF YES, PROVIDE A COPY.
heck Box After Reading; The owner/tontractorldesign professional is responsible for all drainage,and storm water Issues as provided by
Chapter 236 of the Town Code. APPLICATION IS HEREBYMADE 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 taws,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.
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Application Submitted B rt f� me wner
; A, thorixed Age t ❑O
pp y{p " )
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OFL P,--—)
being duly sworn, deposes and says that(s)he is the applicant
(Name of inclivid1jal signing contract) above n med,
(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
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tary Public �o wllwlllrr1/ter
*�" N
o,
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner) c rc '
a a r. orf,
!, residing at
Q�� �I
do hereby authorize UWi to apply on
my behalf t the Town of SoLlthafuilding Department for approval as described herein.
' g i 2 3,
Owner's Signature Date
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Print Owner's Name
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