HomeMy WebLinkAbout51296-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#: 51296 Date: 10/21/2024
Permission is hereby granted to:
John Forni
2140 Bay Shore Rd
Greenport, NY 11944
To:
Construct an accessory pool house with pergola, outdoor shower and outdoor gas fireplace as applied
for per manufacturers specifications.
Premises Located at:
2140 Bay Shore Rd, Greenport, NY 11944
SCTM#53.-4-26.1
Pursuant to application dated 08/26/2024 and approved by the Building Inspector.
To expire on 10/21/2026.
Contractors:
Required Inspections:
FOOTING/REBAR, FOUNDATION 1ST, FRAMING/STRAPPING , PLUMBING, ELECTRICAL- ROUGH, ELECTRICAL-
FINAL, DRAINAGE, FINAL,
Fees:
Accessory-New Structure $587.00
CO Accessory Structure $100.00
Total $687.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box H 79 Southold, NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 °
Date Received
V
For Office Use Onlyo
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PERMIT NO. Building linspector: SI rye
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Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an m
Owner's Authorization form 1Page 2)shall be completed. " ...
Date:August 23, 2024
OWNER(S)OF PROPERTY:
Name:John Forni =CTM
1000-53-04-25 &26
Project Address:2140 Bay Shore Road Greenport NY 11944
Phone#:646-460-3274 Email:fabiofornil@gmail.com
Mailing Address:2140 Bay Shore Road Greenport NY 11944
CONTACT PERSON:
Name:JOhn Forni
Mailing Address:2140 Bay Shore Road Greenport NY 11944
Phone#:646-460-3274 J Email:fabiofornil@gmaii.com
DESIGN PROFESSIONAL INFORMATION:
Name:Brendan M Maloney
Mailing Address:20 Dewey Lane Hampton Bays NY 11946
Phone#:631-965-1855 Email:draftdesign@optimum.net
CONTRACTOR INFORMATION:
Name:TBD
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
F21 Other Accessary Structure .'A $
Will the lot be re-graded? ❑Yes MNo Will excess fill be removed from premises? ❑Yes FNo
PROPERTY INFORMATION
Existing use of property:Residential Intended use of property:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R_40 this property? ❑Yes �No IF YES, PROVIDE A COPY.
® 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 220.45 of the New York State Penal Law.
Application Submitted By(print name): 9"
fly /o � ElAuthorized Agent INOWner
Signature of Applicant: Date: RA&1-d
STATE OF NEW YORK)
SS:
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
day Of
t y Public
�' a Dawn Johnson
Notary Public,State of New Yorls
y r W m No OIJ06249053
�P
(Where the applicant is not the owner) �,�a
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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