HomeMy WebLinkAbout50504-Z tF81 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 #: 50504 Date: 4/2/2024
Permission is hereby granted to:
Moraitis, Simone ....................................� ... _---..........................................................................mm.
- ....__.................... —a...... ���..........�...............................................����..m........
6 Blenheim Dr.ee„�.�_
Manhasset, NY-1 1030
To: Construct an in-ground swimming pool to an existing single-family dwelling as applied
for. Pool and pool equipment must maintain minimum side and rear setbacks of 15 feet.
At premises located at:
2045 Willow Dr, East Marion
SCTM # 473889... ....... — _ .._... ...
Sec/Block/Lot# 22.-5-2
Pursuant to application dated 2/20/2024 and approved by the Building Inspector.
To expire on 10/2/2025. _a
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO- SWIMMING POOL $100.00
......
..........................................................................
Total: $400.00
...................................................... .....------.-.------ .�� .............._
Building Inspector
°";; TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O.Box 1179 Southold,NY 11971 0959
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� Telephone (631) 7654802 Fax(631) 765-9502 l��tp
Date Received
APPLICATIONFOR, U .DNG PERIVIIII (
°
For Office Use Only
PERMIT NO. �" D i— BuildingIns ector:—J-4b, FER
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an ;
Owner's Authorization form(Page 2)shall be completed_
y _ �_ �-�
Date: n
OWNER(S)OF PROPERTY:
Name: y ern,O1iu.i k kegs LLB SCTM#1000-
Project Address: S ; lam-bf�, �O�g� �w l
Phone#: Email: h Orvi 2 b(,l i(c(r o
Mailing Address:. b$b Y S ` 1 1Le3
CONTACT PERSON:
Name j (� - c i SeJV,�ce
Mailing Address: 2d . 10 1 1 i't- S I'J)aJ 17L2Cn
Phone#: 631-5C9 I Email:
DESIGN PROFESSIONAL INFORMATION:
Name: ,
f�
Mailing Address: P, � I I t/1 Df4 Iv
Phone#:_S 14 — 110 _53q�— Email: (`I�1 Rt�-
CONTRACTOR INFORMATION:
Name:
Mailing Address: MY 10VI
Phone#: --1 Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
PSNew Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other C ti ' 1,�- `� �0
Will the lot be re-graded es , No Will excess fill be removed from premisesT Nes
1
PROPERTY INFORMATION
Existing use of property: v� -I Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
0 , L this property? []YesgNo IF YES, PROVIDE A COPY.
heck Box After' ,eWll ng' The owner/contractor/design professional Is responsible for all drainage and storm water Issues as provided by
Chapter 236 of the Town Code. APPLICATION IS 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 building(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): Tenn i '- Lee-A-'� uthorized Agent ❑Owner
Signature of Applicant: Date: `(
STATE OF NEW YORK)
SS:
COUNTY OF �.)
,J-�n`n I�e ✓ '�-e d S being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) 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.
Sworn before me this
rLl\i3,.4
o day of
20
tary Public
rXP,
��.f0 �"` (Where the applicant IS not the owner)
STATE CF
I, W r residing at
eoo "
Kfd�D rd- &N l l-7b3 do hereby authorize a r -P d- to apply on
my behalf the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name 3 u i ry I
2.