HomeMy WebLinkAbout50923-Z - TOWN OF SOUTHOLD
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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#: 50923 Date: 7/10/2024
Permission is hereby granted to:
Palatine Props LLC
27 Service Rd A
Calverton, NY 11933
To: Install in ground swimming pool at existing single family dwelling as applied for.
Maintain mimimum 15 foot setback to rear/side property lines- pool and equipment.
At premises located at:
5675 Bridge Ln, Cutcho ue
SCTM #473889
Sec/Block/Lot# 84.-1-6.14
Pursuant to application dated 5/15/2024 and approved by the Building Inspector.
To expire on 1/9/2026.
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
z' Telephone (631) 765-1802 Fax (631) 765-9502 htt s:l/www.southoldtownn ov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only �
PERMIT NO. Building Inspector,
Date:
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Name: tSr �� SCTM # 1000- — Di — l
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Project Address: 9"S'' f��t be - lC17Cft04 Jk E
Phone#: ,.,. O 1 Email:
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Mailing Address: "
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Name:
Mailing Address ab
Phone#: I Email: �lZ '-C6l y �Cf7�— Cates, .
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Name:
Mailing Address:
Phone#: Email1.:
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Name: r "il`6� i' t ��-
MailingAddress: 9 �� / '/��� kcRb r
Phone#: 631 7,48 8 061
Email +,��v �+ �r`}� �' POO
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❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
�Othest t e V $
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? Fes ❑No
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Existing use of property: Intended use of property:Ec (o L--A)
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yesb IF YES,PROVIDE A COPY.
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to
Application Submitted By(print n e) i� PC TE L—S uthorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
S°
COUNTY OF
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j�� Pe e�—S being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the l -71) E-
(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.
ARBAPA H.TANl' Y
Sworn before me this ,Notary Public,State Of NewYark
fdo. OI TA6086001
(� Cluelified In Suffolk Cou
day of 2 0-0 7
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
1, residing at .� :!5M I-tfTb W?J
d pbi 4'r to apply I on
my b n of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
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Nathan Taft Corwin III
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