HomeMy WebLinkAbout50537-Z �� TOWN OF SOUTHOLD
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d 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 #: 50537 Date: 4/10/2024
Permission is hereby granted to:
Koener, Roseline
PO BOX 274
Westhampton, NY 11977
To construct accessory pool house as applied for per SCHD approval.
At premises located at:
435 Maple Ln, Green port
SCTM # 473889
Sec/Block/Lot# 35.-8-1.3
Pursuant to application dated 3/5/2024 and approved by the Building Inspector.
To expire on 4/10/2025.
Fees:
ACCESSORY $371.00
CO-ACCESSORY BUILDING $100.00
Total: $471.00
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Building Inspector
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 https://ww.sotholdtow ny ors
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only ' �v// E
PERMIT NO. Building Inspector.
-
Applications and forms midst be filled cut in their entirety.Incomplete,
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Date: ¢
OWN OF PROPERTY-.
Name: A0Qt J-kim#1000-
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Project Address: 3 S'" LP 0
Phone#: 61 26 Email: �'
Mailing Address:
CO ACt 09
Name: 4" L. 2ve,' f
Mailing Address: t/ f !1 �s C2 �r
Phone#: ,� :� Email:
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OESIGN"P "ION" I FO A+ 1I'1ON
Name: A3
r
Mailing Address: V0 4 .
Phone#: ( Email: fV�Q.y 'wi
ICONMCMR INFORMATION:
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Mailing Address: i I
Phone#: "?- Finall:
0000"ION OFPROPOSED CONSTRUCrION
XN-ew Structure Add" iqn ❑ lteratican Cl repair ElDemol"Itlon Estimated Cast of Project:
Llother
Will the lot be re-graded? ❑Yes a Will excess fill be removed from premises? [:]Yes0
1
PROPERTY INFORMATION
Existing use of property: W .l Intended use of property: [ {
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Ye - 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. 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 210.45 of the New York State Penal Law.
Application Submitted By(pri me): ❑Authorized Agent wner
Signature of Applicant: Date:
STATE OF NEW YORK)
S :
COUNTY OF
�. being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)a ove named
(S)he is the 1
(Contract r,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 efolre me this
—5day of � -' A ,2024' � ...
NOf bl' ' ffD`i .afA6
14ct3ry public,"State of ME"'Y l
c, )ST%7i 79
'
PROPERTY OWNER AUTHORIZATION IliP �o an 6
drrirlll591ork -i
Fxp
(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
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Oak
Scott A. Russell SUFFCX� ,;F01KMWAX]EIK
SUPERVISOR I��l[Al�A��G�]El�ul[]EI�IC'
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SOUTHOLD TOWN HALL-P.O.Box 1179 Town of Southold
53095 Main Road-SOUTHOLD,NEW YORK 11971
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: .-
Date:
Contact Information:
iEhail&Telephone Numbed
1
Pro erty Address / Location of Construction Site:
District
Section Block Lot
YYY ~n^TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT
Area of Disturbance is less than I Acre. No 5,1 .D•E S• Permit is RecLutred r
Project does Not Disc'harge"to Waters of the State`. N S P D•E.S, Pern11 ss ile titr I
j 0 •- Area of Disturbance is Greater than I Acre & Storm water Runoff Discharges Directly
to Waters of the State of New York. THE APPLICA,NT MUST OBTAIN a SP.D.E.S. Permit
DIRECTLY From N.Y.S. D.E.C. Prior to Issuance of a Building Permit.,
Area of Disturbance is Greater than I Acre & Storm-water Runoff Flows Through Southold
❑ Town's MS4 Systems to Waters of the State of New York, THE APPLICANT MUST OBTAIN
hold Town En ineerrn I e artrnent {
Prior to issuanceof.S_ Permit ap Building ePermit,
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Reviewed Bye Date: FL
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Suffolk County Executive's Office of Consumer Affairs o
VETERANS MEMORIAL HIGHWAY * HAUPPAUGE, NEW YORK 11788 ,
DATE ISSUED: 8/22/2001 No. 29373-H
SUFFOLK COUNTY
a
Home Improvement Contractor License
This is to certify that PAUL J DAVEY
doing business as SLIGO CONSTRUCTIION CORP
( having furnished the requirements set forth in accordance with and subject to the provisions of applicable laws, rules
and regulations,of the County of Suffolk, State of New York is hereby licensed to conduct business as a HOME
IMPROVEMENT CONTRACTOR, in the County of Suffolk.
Additional Businesses
� f
NOT VALID WITHOUT
DEPARTMENTAL SEAL
AND A CURRENT
CONSUMER AFFAIRS
ID CARD
Director
i
i
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Suffolk County Dept of
, Labor,Licensing&Consumer Affairs
, Ff
HOME IMPROVEMENT LICENSE
Name
PAULJDAVEY
Business Name
SLIGO CONSTRUCTION CORP
This certifies that the
bearer is duly licensed License Number H-29373
by the County of suffolk Issued: 08/22/2001
ROSOAZe,P"a- Expires: 08/01/2025
Commissioner
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