HomeMy WebLinkAbout49674-Z TOWN OF SOUTHOLD
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 #: 49674 Date: 9/12/2023
Permission is hereby granted to:
DelVa lio Cesare
PO BOX 369
Peconic, NY 11958
To: construct accessory pergola as applied for.
At premises located at:
4045 Bridge Ln, Cutcho ue
SCTM # 473889
Sec/Block/Lot# 84.4-11.2
Pursuant to application dated 6/7/2023 and approved by the Building Inspector.
To expire on 3/13/2025.
Fees:
ACCESSORY $253.60
CERTIFICATE OF OCCUPANCY $50.00
Total: $303.60
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Id Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971-0959
Telephone(631) 765=1802 Fax(631) 765-9502 httDS.//WWw-Southoldtownny. ov
b'
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. BuildingInspector: 'JUN I'W
3
P
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant Is not the owner,an
I F
Owner's Authorization form(Page 2)shall be completed.
Date;
OWNER(S)Of PROPERTY.
Name: tV w SCTM#1000-
Project Address: 401—\S
Phone#: l .�� � •--1 Email:
Mailing Address:
CONTACT PERSON:
Name: Jennifer Del Vaglio
Mailing Address: PO Box 369 PeconiC, NY 11958
Phone#:631-734-7600 Email:cj@eastendpoolking.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: Eastern End Pools, DBA East End Pool King
Mailing Address: PO Box 369 Peconic, NY 11958
Phone#: 631-734-7600 Email:cj@eastendpoolking.com
ct@eastendpoolking.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑Re
le I pair ❑Demolition Estimated Cost of Project:
2ONiehweStructure ❑Addition
❑ ration
" 11111 1
Will the lot be re-graded? ❑Yes ii No Will excess fill be removed from premises? RYes ONO
1
PROPERTY INFORMATION.
FaExistin use ofproperty: Singlemily Dwelling Intended use of property: Single Family Dwelling
Zone or use district in which premises is situated: Are there any covenant and restrictions with respect to
Residential this property? ❑Yes o 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. APPUCATION IS HEREBY MADE to the Building Department for the issuance of a Buliding Permit pursuant to the Building Zone
Ordinance of the Town 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 anddn building(s)for necessary Inspections,False statements made herein are
punishable as a Gass A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name):Jennifer Del Va lio
Authorized Agent wner
Signature of Appllcan A��__ Date:
STATE OF NEW YORK)
SS:
COUNTY OF ),
being duly sworn,deposes and s says that he is th
Y ( ) a applicant
(Name of indlvi gal signing contract)' ovenamed,
(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
day of 20
Notary Public
(Where the appllcant is riot the owner)
a
residing at 1 �,Y c" . It 9L
re �'
1
do hereby authorize
_to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owhe✓'e`s Signature Date
Print Owner's Name
2
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