HomeMy WebLinkAbout47928-Z �o�SUE- Fo TOWN OF SOUTHOLD
ay BUILDING DEPARTMENT
ti i TOWN CLERK'S OFFICE
o • 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#: 47928 Date: 6/7/2022
Permission is hereby granted to:
Racanelli, Steven
175 Oxford Blvd
Garden City, NY 11530
To: Remove existing in-ground swimming pool and components at existing single family
dwelling as applied for.
At premises located at:
1200 Arbor Ln., Mattituck
SCTM #473889
Sec/Block/Lot# 121.-1-1.9
Pursuant to application dated 5/4/2022 and approved by the Building Inspector.
To expire on 12/7/2023.
Fees:
DEMOLITION $100.00
Total: $100.00
Building Inspector
o��SufFOL��oG TOWN OF SOUTHOLD—BUILDING DEPARTMENT
yz Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
oy�o• ��o�� Telephone (631) 765-1802 Fax (631) 765-9502 https://www.southoldtownnygov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only D
PERMIT NO. Building Inspector: MAY O 4 2022
Applications and forms must be filled out in their entirety. Incomplete BUILDING DEPT.
TO WN OF SOUTHOLD
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: ti L
OWNERS)OF PR PERTY:
Name: A oJe� A 4-,A cJe SCTM#1000-
'\---A
Project Address: 0 r s,0 i N� )`� �1
Phone#: SA 6 " � `C�v Email: �J�A-�,-- � v A 6J
Mailing Address: S Ox-&'A CAr- e `\ Iv-J. � 0
CONTACT PERSON:
Name:
Mailing Address: f
Phone#: Email: ��fl� �V�J , c-0
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone'#: Email:
CONTRACTOR INFORMATION:
Name: Sly nn 1 1►i
Mailing Address: i
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Altera 'on RepairKDemolition Estimated Cost of Project:
other 1_�--
Will the lot be re-graded? ❑Yes El No Will excess fill be removed from premises? ❑Yes ❑No
1 -
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ❑No 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
Signature of Applicant: �A �.A V' Date: �I4j 12L
STATE OF NEW YORK)
SAS:
COUNTY OF S LkeaSte- � )
verb Eoran C 1 l 1 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
Lf day of I I IQ,� , 20 ej r) 4) A ij
Notary Public
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
PROPERTY OWNER AUTHORIZATION NO.01 DW6306900
Y(Where the applicant is not the owner) COMMISSION EXPIRES JUNE 30,2 QUALIFIED IN SUFFOLK COUNT0jp,
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
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