HomeMy WebLinkAbout50977-Z TOWN OF SOUTHOLD
a BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
Yy SOUTHOLD, NY
"am 6 Y T2p .
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 #: 50977 Date: 7/23/2024
Permission is hereby granted to:
Na olitano, Thomas
343 Van Wan ner PI
Williston Park, NY 11596
To: construct accessory in-ground swimming pool as applied for. Pool equipment shall be
located in the rear yard with minimum 15' setbacks to lot lines.
At premises located at:
1275 White Eagle Dr, Laurel
SCTM #473889
Sec/Block/Lot# 127.-9-20
Pursuant to application dated 6/3/2024 and approved by the Building Inspector.
To expire on 1/22/2026.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $300.00
CO- SWIMMING POOL $100.00
Total: $400.00
Building Inspector
86 d f
� F� , TOWN OF SOUTHOLD—BUILDING DEPARTMENT
,�pF Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 htt s:'/www.soutlioldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
3 202
PERMIT NO. SN-,E/7 Building In ,laectnr., wJUN �.�
Applications and forms must be filled out in their entirety. Incomplete Building Department
applications will not be accepted. Where the Applicant is not the owner,an Town of Southold
Owner's Authorization form(Page 2)shall be completed.
Date:IS
OWNER(S)OF PROPERTY:
Name: . I #1000-
Project Address:
Phone#: � — if n
ail;
Mailing Address: , 27A
CONTACT PERSON:
Name:
Mailing Address:
Phone#: ?)LL
L� Email:
DESIGN PROFESSIONAL INFORMATION:
Nam
Mailing Address:
Phone#: Email: ETA
CONTRACTOR INFORMATION:
Name: E3bn(hJ -r.
Mailing Address:
Phone#: (��J Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
few Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Est' ted Colt of P oJect:
❑other
Will the lot be re-graded? ❑Yes Will excess fill be removed from premises? ❑Yes N
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any cove is and restrictions with respect to
this property? ❑Yes 2!� IF YES, PROVIDE A COPY.
Ga
heck o After eading: The owner/contractor/design professional is responsible for all dz 0age and storm water issues as provided by
er 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
ante 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 (ip tit name)- hori ed Agent ❑Owner
Signature of Applican Oa
STATE OF NEW YORK) � �� ,-\JIrr��"`��
"w o
COUNTY OF
O.
JA being duly sworn, deposes anus t a pllcant
(Nam of indivi aI signing contract)above named, 0 �' "�"•' ��
(S)he is the r r
(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
r
of ,
---f�
Otary PUbIIC
. PLp�;,,
OPERTY OWNERAUTHORIZATION" Nhere the applicant is not the owner)
kjye14Pg at 276 VJHt5 r.
do hereby authorize to apply on
my behalf to the Town of Southold Building DepOwwof9f,approval as clescrnbed herein01
o, W
Owner � �'s Sin ate
cra: o" r4- �4'o
' ,,, q,�c6o,/*
Print Owner's Name '. ••" ��'
�'djr�rrarlrrltr�'�"��Z
MCI
\ �A y �. A v - s.� �� -
\,., \\ \ `
s \ \
_ �...�,.. ymow —
vv
01
\ \ \
CIA-
ARM
a
F _
0
-
\ = v
.�
F: 4,
VA �
MEMO
-05
\\
\� � A
\
PER
EAWWO 'KNANC III
_ >.
\�ff
A\O
���
� � � � � �