HomeMy WebLinkAbout49277-Z � TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, NY
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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 #: 49277 Date: 5/18/2023
Permission is hereby granted to:
Lieberman, Nancy
315 Maple Ln
Southold, NY 11971
To: construct accessory in-ground swimming pool as applied for.
At premises located at:
155 Old Shipyard Ln Southold
SCTM # 473889
Sec/Block/Lot# 64.-5-2
Pursuant to application dated 4/18/2023 and approved by the Building Inspector.
To expire on 11/16/2024.
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
k Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
z Telephone (631)765-1802 Fax(631) 765-9502 bttps://W%ANN,.sotilliol(,]I(Iwnny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only sa
PERMIT NO. Building Inspector-....... 1AI APR1 18 2023 �
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Applications and forms must be filled out in their entirety.in mplete.
applications will not be accepted. Where the Applicant isnot the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: April 17, 2023
OWNER(S)OF PROPERTY:
Name. Nancy Lieberman SCTM#1000- 64.-5-2
Project Address:155 Old Shipyard Ln. Southold NY 11971
Phone#: Email:
Mailing Address:
CONTACT PERSON:
Name: Ural Talgat
Mailing Address: 436 7th Street, Greenport, NY 11944
Phone#: 631 477 8963 Email: ural59@hotmail.com
DESIGN PROFESSIONAL INFORMATION:
Name: Ural Talgat
Mailing Address: 436 7th Street, Greenport, NY 11944
Phone#: 631 477 8963 Email: ural59hotmail.com
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
bother New Swimming Pool 100,000
Will the lot be re-graded? ❑Yes kNo Will excess fill be removed from premises? 'RYes LINO
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PROPERTY INFORMATION
Existing use of property: Single Family Residence Intended use of property: Single Family Residence w/new Pool
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 this property? Dyes I0lNo IF YES, PROVIDE A COPY.
❑ Check Box After heading: The Icootracwt professional Is respansiMe for all drainage and storm water Issues as provided by
Chapter 236 of the Town code.Af"irUCAIRON K HEREBY MADE to the Builds Department for the issuance of a Building Permit pursuant to the Building zone
Ordinance of the Town of Southold,Suf lok Cmunty,New York and other applicable law;Ordinances or RegulalkwA,for the construction of buMng%
additions,alterations or for renwval or demolffio t as herein descrflxxL The applicant to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and in WIding ;)for necessary inspections.False statements made herein are
punishable as a Class A misderneanor pursuant to Sectlon 218.45 of the New York§tate Penal Law.
Application Submitted By(print name): Ural Talgat IYAuthorized Agent []Owner
Si nature of A licant: w _ Date: /
g PP .-
STATE OF NEW YORK)
SS:_
COUNTY OF �W
Ural Talgat being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Architect
(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
!?"'day of ak( 1_ ,20 3
Notary Public
LAURE14 M.IU CMSSICK
of Now YA
PROPERTY OWNER AUTHORIZATION r�l�ubl1MC634230
l�l�.of l�le��la�n8
C uslifled In Suffolik COU
(Where the applicant is not the owner) Commisslon exow May 23
I, residing at Q 144rane_
do hereby authorize Ural Talgat to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
119
.094,93 1
's SignatureDate
P64 Owner's Name
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