HomeMy WebLinkAbout51132-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERKS 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#: 51132 Date: 08/28/2024
Permission is hereby granted to:
Philippe Jacquet
PO BOX 142
Orient, NY
To:
construct accessory in-ground swimming pool with deck as applied for.
Premises Located at:
710 Grandview Dr, Orient, NY 11957
Section\Block\Lot # 14.-2-3.34
Pursuant to application dated 07/16/2024 and approved by the Building Inspector.
To expire on 02/27/2026.
Contractors:
Required Inspections:
FOOTING/REBAR, ELECTRICAL- ROUGH, ELECTRICAL- FINAL, DRAINAGE, FINAL,
Fees•
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
ACCESSORY $99.00
CERTIFICATE OF OCCUPANCY $100.00
Total $499.00
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TOWN OF SOUTHOLD— BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971 0959
Telephone (631) 765-1802 Fax (631) 765-9502 1°t /ww s i.ctlioldtowni,l wg ,Y
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only D
PERMIT N0. Building Inspector:_.... L 1 6 202
Applications and forms must be filled out in their entirety. Incomplete BUMDINGDO
applications will not be accepted. Where the Applicant is not the owner,an T( W-N -}FSU(J•t' o F
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF P OPER
SCTM# 1000-
Name:
Project Address: � U �p,�\v q,t
Email: ��.._. ._.. .
Mailing Address;
CONTACT PERSON:
Name: "
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:.
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: � ` Email: �r C
DESCRIPTION OF PROPOSED CONSTRUCTION
New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estlm Lted Cost'ofProject:
❑Other $-
Will the lot be re-graded? ❑Yes 1�so 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 ONO IF YES, PROVIDE A COPY.
❑ Check BoxAfter 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): mp
�T1 j ❑Authorized Agent ❑Owner
Signature of Applicant: CONNIE INCH
otary Public,State of New York
No.01 BU6185050
STATE OF NEW YORK) Qualified In Suffolk County
SS: Commission Expires April 14,2R�
COUNTY OF )
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
r
day of , 20 a�� y M E
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
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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SITUATE AT ORIENT
TOWN OF SOUTHOLD
SUFFOLK COUNTY,NEW YORK
FILED:JUNE 8,1982,MAP#7083
CERTIFIED TO:PHILIPPE JACQUET 0 r T u;S ?,;"?
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