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HomeMy WebLinkAbout51121-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE w� a SOUTHOLD, NY w uw 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 #: 51121 Date: 8/23/2024 Permission is hereby granted to: Gutherz, Sophia 235 W 76th St Apt 2C New York, NY 10023 To: construct accessory in-ground swimming pool with spa as applied for. Pool equipment shall be located in the rear yard with minimum 25' setbacks to lot lines. At premises located at: 4230 Grand Ave, Mattituck SCTM # 473889 Sec/Block/Lot# 107.-2-2.6 Pursuant to application dated 7/12/2024 and approved by the Building Inspector,. To expire on 2/22/2026. Fees: SWIMMING POOLS -IN-GROUND WITH FENCE ENCLOSURE $300.00 CO- SWIMMING POOL $100.00 Total: $400.00 Building Inspector �I6.r�Y� `�G14�V4c ! '� i �"i - i.Vo'1C( tiIa'4- � �rr�w'w� t�� � I� tt �taBil °.Mvo� . TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 :24 Telephone (631) 765-1802 Fax (631) 765-9502 litt s://Nvm .soutlioldtonLLm2� 'w16Ja:i:M1f J� Date Received BUILDINGAPPLICATION FOR For Office Use Only �dL Y 1.\ D PERMIT NO, Building Inspector. JUL 1 2 2024 W-m—o" Z�:A Applications and forms must be filled out in their entirety. Incomplete applications will not be accepted. Where the Applicant is not the owner,an BUILDING DEPT. Owner's Authorization form(Page 2)shall be completed. TOWN =jF SOUTHOI Date: I � � OWNER(S)OF PROPERTY: Name: So SCTM #1000- Project Address: ) A� %tu I Phone#: Email: Mailing Address: -- CONTACT PERSON: Name: 1 Mailing Address: Phone#: ' Email: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: TTM71 CONTRACTOR INFORMATION: Name: AnL Mailing Address: �U r44 l i Phone#: 1_ Q� `--I Email: lei 1S f DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration []Repair ❑Demol�����+ Poo Estimated Cost of Project: VOther w ci i Y $ Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? es [:]No 1 PROPERTY INFORMATION Existing use of property: '�5{"~ 'e Intended use of property: I S4wmmlnq Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to this property? ❑Yes ilo IF YES, PROVIDE A COPY. Epte heck Sox After Reading: The owner/contracctoor/design professional Is responsible for all drainage antistorm w atewr issues as pr*vNded by r 256 of the Town Code.. APPUCA'TION 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): I(y)er��© Authorized Agent ❑Owner Signature of Applicant: d Date: _11 I a bL4 STATE OF NEW YORK) COUNTY OF 5 5 S; C*r w" being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the �- QoDntractor,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 � f . day of R ZD ., Notary Public VICTORIA A FERREMI Notary Public-State of New York PROP OWNER AU ZATION No,fr1Fi Suffolk c E y o is not the lowner) Qualified in Suffolk County My commission Expires Mar 14, 2026 (Where the applicant W NOW 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 Buildin&Degar nne t Allplication AUTHORIZATION (Where the Applicant is not the Owner) I 7 H t A Cqq C , residing at "7� � (Print property owner's name) (Mailing Address) do hereby authorize (Agent) 1f� o to apply on my behalf to the Southold Building Department. (Owner' Signature) Date (Print Owner's Name) r� jJ V, lip 1 , 4'a 7' R i a + I . 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