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HomeMy WebLinkAbout49622-Z t ` TOWN OF SOUTHOLD BUILDING DEPARTMENT 91, TOWN CLERKS 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 #: 49622 Date: 8/28/2023 Permission is hereby granted to: Hoeltzel, M_, ary w,, __ 213 Orchard Wa Wayne, PA 19087 To: Construct an inground swimming pool to an existing single-family dwelling as applied for. Pool and pool equipment must maintain a minimum front yard setback of 40 feet and a minimum side yard setback of 10 feet. At premises located at: 6190 Great Peconic Bay Blvd Laurel SCTM #473889 Sec/Block/Lot# 128.-2-5 Pursuant to application dated 7/24/2023 and approved by the Building Inspector. To expire on 2/26/2025.IT 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 IWI Amex 54375 Main Road p. 0. Box 1179 Southold,NY 11971-0959 Telephone(631)'765-1842 Fax(631) 765-950 Date Received APPLICATION BUILDING , For Office Use Only LC PERMIT NO. JUL "' Building Inspector: ;.,)" Applications and forms must be filled out in their entirety.Incomplete applications will not be accepted. Where the Applicant Is not the owner,an T011 IV Ownees Authorization form(Page 2)shall be completed. Date: OWNER(S)OF PROPERTY: Name: 7AI AI _ SCTM#1000- Project Address: l� Phone#: Vol Email: Mailing Address: CONTACT PERSON: Name: Mailing Address: LAfA 1 h & Phone#: 31 7"q J9 I— Email• DESIGN,PROFESSIONAL INFORMATION: Name:-,,,,,,% Mailingµ ng Address: Phone#: Email: CONTRACTOR INFORMATION: Name: g r t4 VL_ Mailing Address: Phone#: Email 14rolE uLrN �i I , DESCRIPTION;OF„PROPOSED CONSTRUCTION eration ❑Repair ❑Demoliti Estimated Cost of Project: ❑Other QN�,v Structl�re i Addition ❑Alt $ Will the lot be re-graded? ❑Yes o Will excess fill be removed fromp remises? INhes ❑No 1 PROO fNFOR IAWhf- Existing use of property: Intended use of propertyR 6x e2rf) Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes o IF YES,PROVIDE A COPY. r� of Reading The�rner/comractor/design professional is responsible for all drainage and storm waterlssuewas provided by O qe� N AtON 13 HEREBY RAADE to the Building Department for the issuance otaBulldhii Permit pursuant to the Building zone � tbqh Ntf"puah ,SuffnZioawNew Yorkand other applicable Laws,Ordinances or Reguhnions,for the coasdyctlon of 6ulldings, , . a� n r r red a rai rd tngl ion "hetgiin desodbed.the appltcarrt agrees to SomplywlNi all.appllcable laws,ordinances,building code, G s� C1 �naagtf o%adm�uit s r low&Inspectors on;premisg andln buifding(s�;for necessary lnspeRions Falsestatements made herein are 1PtN�ie'•, 5 a t�°;phi�dnpr p�rr�tila to-Sectlon210.45 of the New York State Penal Law. Application Submitted By(print n e) � ' - Authorized Agent ❑Owner Signature of Applicant: Date: . J STATE OF NEW YORK) SS. COUNTY 01`1 �?i ( 0 RE being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the O. (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 now edge and belief,and that the work will be performed in the manner set forth in the application file therewith. 9( . BARBARA H.TANDY New York Notary Public,State Of N w Sworn before me this �+' No. 01TA6086001 Qualified In Suffolk County -7 day of J 20a2> Commission Expires-0#$W Notary Public PROPERTY OWNER I "M (Where the applicant is not the owner) 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 11 2 ffri a 1% ,' sN 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 Po IF YES,PROVIDE A COPYpg., e" mg:# rY!Gd n 4", % M t'' foe i # I�i.,; �1 by 11�0and e h t ��o^* ��I the tM�4d IaGxta `�' CJrp4M�,Ni�F��MADEtatheBaftdbl C 1" N! e i" idi k�� ��a �t�pry ���Fsb�a�ca�trade� 0a ate �, 1 V Application Submitted By(print n e) � '�L3 df�uthorlzed Agent ❑Owner Signature of Applicant: Date: STATE OF NEW YORK) SS: COUNTY OF being duly sworn,deposes and says that(s)he is the applicant (Name of individual signing contras)above named, (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. Swom before me this day of 20 Notary Public PROPERTY ENS AUTHORIZATION (Where the applicant is not the owner) II o�. residing at b - - I, Ng do hereby authorize ►�o to apply on my behalf to the Town of Southold Building Department for approval as described herein. r 1 -? ibw� ) rter's Signature Date t CA.0 i. A� •e,- -4yoLZJ - PrMOwner's ane Ll z Scanned with CarnScanner a gyp, o e _ QUG BY NA71 Ai E IA 14 IRA a a E Z �. tr : e. \ Y a F � t i g W-1 v c ti OA- t ` wo a � �r r e � d m IV Aj iNa v�