HomeMy WebLinkAbout51013-Z TOWN OF SOUTHOLD
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#: 51013 Date: 7/31/2024
Permission is hereby granted to:
Sardar-Afkhami, Ahmad A
580 Jacobs Ln
Southold, NY 11971
To: Construct an inground swimming pool surrounded by a raised patio accessory to an
existing single-family dwelling as applied for. Pool, pool equipment and raised patio
must maintain a minimum side and rear yard setback of 3 feet.
At premises located at:
580 Jacobs Ln Southold
SCTM # 473889
Sec/Block/Lot# 88.-1-9
Pursuant to application dated 6/10/2024 and approved by the Building Inspector.
To expire on 1/30/2026.
Fees:
SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $300.00
ACCESSORY $265.00
CERTIFICATE OF OCCUPANCY $100.00
Total: $665.00
Building Inspector
I TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
;k Telephone (631) 765-1802 Fax(631) 765-9502 htt s:Hwww. olat.holdtownn . ors
Date Received
APPLICATION FOR BUILDING PERMIT °
For Office Use Only p
PERMIT NO. !D 10 Building 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
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: A )A-M kD .000-
Project Address: JT� Z 0,�CZBS (A(NC; !So O-Vr ipL N1{
Phone#: l-4- S1 " ZAP Email: OI,SA.rO�A.�� CD
Mailing Address: S 0.W-"o—
CONTACT PERSON:
Name: Sao,2 as Q b�J�
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR
,INFORMATION:
Name: hw1." Rv6I1,36
Mailing Address: Ili
Phone#: Email: Cl-1fr(Y1pJ rZ124
DESCRIPTION OF PROPOSED CONSTRUCTION
Y s.
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other RQ 0 L-
Will the lot be re-graded? ❑Yes XNo Will excess fill be removed from premises? [ Yes ONO
1
PROPERTY INFORMATION
Existing use of property: Re Si 0\ec.Aa,( Intended use of property: RysTde.+�.�:�(
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
4k G this property? ❑Yes;RNo 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(print name): Authorized Agent ❑Owner
S ent t�
Signature of Applicant: Date: 6' f -_ !-
STATE OF NEW YORK)
SS:
COUNTY OF SUFroUA )
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(Contractor Agten Corporate Officer,etc.)
of said owner or owners,and is duly authorized to p rm 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
2D
dayofn L�n� jia"
- �
Notary Public
TRACEY L. DWYUI=
NOTARY PUBLIC,STATE OF NEVI'YYjiK.
PROPERTY OWNER AUTHORIZATION NO.(NDW6306900
014ALIFIEDfN" UFFOLKd�C��)J'f `
(Where the applicant is not the owner) cOMOSSiON EXPMES JUNE 202.E
/� `%
I, Y'1/� !�Y�Gj c}� G� �ii✓ ff < 6!'►')kesiding at
IN
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
71ri Aic—
Ow er's Signature Date
Iy U112DAR
Print Owner's Name
2
f� BUILDING DEPARTMENT-Electrical Inspector
TOWN OF SOUTHOLD
y Town Hall Annex- 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
w Telephone (631) 765-1802 - FAX (631) 765-9502
r
" iamesh@,southoldtownny.gov-seand@southoldtownny.gov
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All Information Required) Date:
Company Name:
Electrician's Name:
License No.: Elec. email:
Elec. Phone No: ❑I request an email copy of Certificate of Compliance
Elec. Address.:
,JOB SITE INFORMATION (All Information Required)
Name: -
Address: E
Cross Street:
Phone No.:
Bldg.Permit#: S 1 p I email.
Tax Map District: 1000 Section: Block: Lot:
BRIEF DESCRIPTION OF WORK, INCLUDE SQUARE FOOTAGE (Please Print Clearly):
fJ,e�W I to - CP-0UOD }'�doL
X 3d
Square Footage: 2ow
Circle All That Apply:
Is job ready for inspection?: ® YES[J NO F]Rough In Final
Do you need a Temp Certificate?: LJ YES 0 NO Issued On
Temp Information: (All information required)
Service Size1 Ph3 Ph Size: A #Meters Old Meter#
❑New Service❑Fire Reconnect❑Flood Reconnect❑Service Reconnect❑Underground❑Overhead
# Underground Laterals 1 FJ2 H Frame Pole Work done on Service? Y N
Additional Information:
PAYMENT DUE WITH APPLICATION