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Home My WebLink About50233-Z ett , TOWN OF SOUTHOLD N BUILDING DEPARTMENT TOWN CLERK'S OFFICE o 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#: 50233 Date: 1/18/2024 Permission is hereby granted to: Brooksite Inc _ - — 74 BuckleY Rd ......... �.._ .e....... . . .. 72 Patchogue, NY... 117..........— �..�m.__ _ d ........— To Construct an inground swimming pool accessory to a new single-family dwelling as applied for. At premises located at: 80 Deer ....�_ .. Run, Southold:. . ... - � �..._._ W_ ... ..�- a....._........... SCTM #473889 Sec/Block/Lot# 79.4-17.18 2 Pursuant to application dated 1 /15/2023 m and approved by the Building Inspector. 1 pi 9/ 2 To expire on 7/1205._mmmmm Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $300.00 CO- SWIMMING POOL $100.00 Total: � $400.00 .. .........--dz....... Building Inspector tucr., rc 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 htq)s:/,'% w.southoldtovvnnv.gov.%, Date Received APPLICATION FOR BUILDING ILDING P ERM IT For Office Use Only ° � PERMIT NO. 5023Building 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 Owners Authorization form(Page 2)shall be completed. Date: l/ J S a7 :J OWNER(S)OF PROPERTY: Name: t l A1J A u G 4 SCTM#1000- 0"1 — Q —0 "7 • t Project Address: g � ,. ILJI 0) d Phone#: s i 6 — l — 13 Email: O D 9 Y ZZ n L • Mailing Address: '' p Sv„� � a 1 V w s Ir *Y" 1) 7 d CONTACT PERSON: q.� Name: A KL z'17" � p Mailing Address: 70 • e.*+ r S AL.ra _8 Phone#: - )� �b� Email: T ZZ A7 r� DESIGN PROFESSIONAL INFORMATION: Name: 4LK► Mailing Address: ► h'0► h • V y 4, 1 So Meda Phone#: CAA04 —T3 S1 Email: C t o ►. • Li M CONTRACTOR INFORMATION: Name: Mailing Address: h� ( vF M ' C1 , I o - . Phone#: — C Email: �C-0 DESCRIPTION OF PROPOSED CONSTRUCTION ew Structure ❑Addition ❑Alteration []Repair ❑Demolition Estimated Cost of Project: ❑Other ixaLLAn o ' Will the lot be re-graded? ❑Yes 4N Will excess fill be removed from premises? ❑Yes NNo 1 i PROPERTY INFORMATION Existing use of property: E S Q h o ( Intended use of property:%'41 14L F 06R%i l r 1-1 J M Zone dr use district in which premises is situated: Are there any covenants and restrictions with respect to /1 G this property? JtYes El No 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. APPLICATION 15 HEREBY MADE 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 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 buliding(s)for necessary Inspections.False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law. Application Submitted By(print name): ftj(A ,w 1A A L4GW4--At ❑Authorized Agent jlIdOwner Signature of Applicant: Date: s STATE OF NEW YORK) SS: COUNTY OF F`i1004 �Cn\� ) r C A t% Ate► G being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the W h (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 litoday of , 20 3 N tart'P blic "Carolyn S er NOTARY PUBLIC,STATE QP NEWYORX. Registration No..OISN61016 2 PROPERTY OWNER AUTHORIZATION Qualified in Suffolk County Commission Expires November 17,202,""I (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 2 "0' 39 1 sP Scott A. Russell " � � STOIRLIMMAT]EIK SUPERVISOR N IANAGr]ETWTENT SOUTHOLD TOWN HALL-P.O.Box 1179 �y 53095 Main Road-SOUTHOLD,NEW YORK 11971 Town of Southold CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. ) - - - - - - - - — - - - - - - - - - — — — — - - - - - - - - - - — — - APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other) NAME: , t 1A " Date: l O Contact hiformati on: Goa�'7�IZ t1....Q L . Com IC Mad a`Telephone Nnmhet) — d a O Property Address / Location of Construction Site: 10 U 1117( S.C.T.M. #. 1000 District 017i mm Section Block Lot TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT ❑ Area of Disturbance is less than I Acre. No S.P.D.E.S. Permit is Required ! Protect does Not Discharge to Waters of the State. auto S.P.D.E.S. Permit is Reguiied i ❑ - Area of Disturbance is Greater than 1 Adre & Storm water Runoff Discharges Directly to Waters of the State of New York. THE APPLICANT MUST OBTAIN a SRD.E.S. Permit DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Buildin Permit. ❑ - Area of Disturbance is Greater than l Acre & Storm-\,rater Runofl' Flows Through Southold Town's MS4 Systems to Waters of the State of New York. THE APPLICANT MUST OBTAIN a S.P.D.E.S. Permit throu h the Southold Town Engineering Delpartnient Prior to Issuance of a Building-Permit, 1 Reviewed By: Date 1 3 ............. .............. PnR M " CMCP -Tf1C n,tni,ar 9n i e l v t 10 4)C) 141 6'so ddlN (Z) z Ilk' (06 11 j j It �JN 4L, ci 7 p C'V ow C'4 .......... L6 41 9",e30 1* 04 41 y9 ZZ, 14 eg-12 1 /V fe-ee 141 70 1, aq se zz ol 70 SC irLL Azll rz: QM'K