HomeMy WebLinkAbout48525-Z 1
�o�SUFfoi,r�o TOWN OF SOUTHOLD
BUILDING DEPARTMENT
N y� TOWN CLERK'S OFFICE
2
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 #: 48525 Date: 11/22/2022
Permission is hereby granted to:
Insource East Prpts Inc
360 Motor Pkwy Ste 2006,
Hauppauge, NY 11788
To: demolish existing swimming pool as applied for.
At premises located at:
380 Deer Dr., Mattituck
SCTM #473889
Sec/Block/Lot# 114.-10-3
Pursuant to application dated 9/26/2022 and approved by the Building Inspector.
To expire on 5/23/2024.
Fees:
DEMOLITION $100.00
Total: $100.00
Building Inspector
=�o�$OFFO(/�cOG TOWN OF SOUTHOLD—BUILDING DEPARTMENT
H Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
oy�o ao�� Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownnyRo_v
1# �
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
I
PERMIT NO. Building Inspector: SEP 2 � 2022
Applications and forms must be filled out in their entirety.'Incomplete PUILDING D1=11 I:
applications will not be accepted. Where the Applicant is not the owner,an C)F
Owner's Authorization form(Page 2)shall be completed. -
Date:
OWNER(S)OF PROPERTY:
Name: �C�rG_�__ _ .._..-.____ V SCTM#1000
Project Address: 3- — - Df- - - ---- - - -� ==- (-_is LVOL
Phone#: _ r P, Email -
Mailing Address: -._;J60_A _.
CONTACT PERSON:
Name:
Mailing Address: �?
Phone#: J Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structu11re ❑Addition ❑Alteration ❑Repai emolition Estimated Cost of Project:
❑ (`I
Other OM Ch
Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ❑No
PJ D'J��3
l°b 1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ENO 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. APPLICATIONIS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone
Ordinance of the7own 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 nt na e): �� ' 1 ed Agent ❑One
uthorizwr
-------- _ _ _ _
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF SL I"l,g1j K
1 � being duly sworn, deposes and says that(s)he is the applicant
(Name of individual sig64 contract)above named,
(S)he is the
(Contract r,Agent, rporate Officer, etc.)
of said owner or owners, and is duly authorized top m 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
a
h _ L 5t day of22rr► J�. , 20
Ckjotary Public
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
PROPERTY OWNER AUTHORIZATION NO.01 DW6306900
Where the applicant is not the owner QUALIFIED IN SUFFOLK COUNTY-
( pp ) COMMISSION EXPIRES JUNE 30,2A2b
I, 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
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AP ROVED AS NO ED
DATjy
B.P.#
FEE: BY:-- .-
NOTIFY BUILDING DEPARTMENT AT
765-1802 8 AM TO 4 PM FOR THE
FOLLOWING INSPECT 1ON&
1. FOUNDATION - TWO REQUIRED
FOR POURED CONCRETE
2. ROUGH - FRAMIi,'G & PLUMBING
3. INSULATION
4. FINAL - CONSTRUC.T!ON MUST
BE COMPLETE Fl.-''m- C.O.
ALL CONSTRUCTION SI-!A.LL MEET THE
REQUIREMENTS OF THE CODES OF NEW
YORK STATE. NOT RESPONSIBLE FOR
DESIGN OR CONSTRUCTION ERRORS.
COMPLY WITH ALL CODES OF
NEW YORK STATE & TOWN CODES
AS REQUIRED AND CONDITIONS OF
�T�gni y Tnriti7I�a
Srr>TNnI-aLa +Nls BOARD
O�i�WN�fi�t,'STEES
Pl,Y c ncr,
3 Nature of•work,(e ckg44h 4pplicable):New Building .....':..'.. Addition .......... Alteration .
Repair ; lie oval ............. Demolition .............:Other WorlPPx?�.y.��s .
met lT�� i (Description)
4. .Estimated Cost, ......................... Fee ...... ............... ..... ......... _
..w
(to be paid on filing this application)
S.`—If dwelling,number of dwelling units ............... Number of dwelling units on each floor.......... E (l(ln
Ifgarage,number of cars .. .................................... ..�
6. If business,commercial or mixed occupancy,specify nature and extent of each type of use ................ .. SEP.
7. Dimensions of existing structures,if any:Front............... Rear .... .......... Depth . G
Z
Height ...............N4mber of Stories ............... �';'.Dimensions of same structure with rations or additi ns:Front ................. Rear ............... .. j `��[LL7(� . 0 a7
Depth ..................c.. �i t ip..........Number of Stories......................
--S. Dimensions of entire new on c .�11�`M ..... Rear .. .... ... Depth .....
Heightr e. . ..................................................
9. Size of lot:Front . `��a_rD�eppth ...............
10. Date of Purchase ...Name of Former Owner ,Depth
. h.
11. Zone or use dist i .................. ..................... ..............
12. Does!proposed goo 1 y ,ordinance or regulation: .............................
13. Will lot be regra d Will excess fill be removed from premises: Yes �
14. Namg of Owner s ' !�...fIfIddress'41Q 46y,.466 Phone Noah:F-M—R,
Nommof t :� V.........Address ./.A,+�rJ�Tic�C . ....
Name of Contractor .. ..............Address ...................Phone No.
PLOT DIAGRAM
Locate clearly axid distinctly1 buildings, whether existing or proposed, and,indicate all setback dimensions from
property lines.Give street and bloc number or description according to deed,and show street names and indicate whether
interior or corner lot.
/p x
X _ C
. IV x-fie '
i, APPROVED AS MUTED
DATE: Q,i� 9.P '•/
b9ln`
NOTIFY BUILDING DEPARTMENT AT
•. 765.1802 9 AM TO 4 PM FOR THE
FOUAVANG INSPECTIONS:
1 FOUNDATION TWO REQUIRED
FOR POURF:M+:ONCRECE
2, ROUGH FFI, :':IVIG&PLU! 31NG
3. INSUI.ATIO--
4.FINAL Ct. •'nUCTION MUST
I BE COMP1.; , . :OR C.O.
ALL CONSTRUt• -)N SHALL MELT
THE REQUIREArC•'••S OF THE KY
STATE CONSTkoo TION&ENERGY
STATE OF NE Y K CODES.NOT RESPONSIBLE POR
COUNTY O .. .... S'S DESIGN O'3 rn �"°.•..,C•r, ^r3AS.
•�•• •• being duly sworn,deposes and says that he is the applicant
.1.
(Name of individual signing contract)
above named.
,PHeisthe .... ....... "l�' .................................. .. .........................
(Contractor,agent,corporate Qf(ider,etc.)
of said owner or owners,and is duly ly 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 knowledge and belief;and that the
work will be performed in the man4er set forth in the application filed therewith.
Sworn to before me this
..... .. ......... 194
Notary Public, �:.n:. YbvM.K�........... County
NOTARY PUBLIC,5j1*of Not,Yuck
No,4671306•Sulloik County
CaaslWRnlo�irl,Moen30.IP�o •••••• •• ••• •• ••• •••••••••••••.••••.
(Signature of applicant)
' I