HomeMy WebLinkAbout51304-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#: 51304 Date: 10/22/2024
Permission is hereby granted to:
Kirkland DA Revoc Trt
2275 Deep Hole Dr
Mattituck, NY 11952
To:
Construct an inground swimming pool accessory to an existing single-family dwelling as applied for.
Pool and pool equipment must maintain a minimum side and rearyard setback of 5 feet.
Premises Located at:
2275 Deep Hole Dr, Mattituck, NY 11952
SCTM# 115.-14-14
Pursuant to application dated 09/03/2024 and approved by the Building Inspector„
To expire on 10/22/2026.
Contractors:
Required Inspections:
FOOTING/REBAR, ELECTRICAL- ROUGH, ELECTRICAL- FINAL, DRAINAGE, FINAL,
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total $400.00
........... ju
Building Inspector
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 litt s:HwNvNv, o tholdtownriL o
o-
Date Received
APPLICATION FOR BUILDING PERMIT
I 9
.11 avol i
For Office Use Only
PERMIT NO. Building Inspector;—JA�& �U � �� '
Applications and forms must be filled out in their entirety. Incomplete T011DIt
applications will not be accepted. Where the Applicant is not the owner,an SO UT1101
Owner's Authorization form(Page 2)shall be completed. "
Date: q
OWNER(S)OF PROPERTY:
Name: SCTM #1000-
Project Address: Q2 IC`a r\,Jc
Phone#: y� Email:
Mailing Address:
CONTACT PERSON:
Name: KQLwCA
Mailing Address: 5ql
ke-
Phone# _ "1 -' � Email: S t\ ,
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
S
Mailing Address: a S O U
Phone#: . Email:
Wncf
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Other" '�C $
Will the lot be re-graded? I9Yes El No Will excess fill be removed from premises? ❑Yes ly0
1
PROPERTY INFORMATION
Existing use of property: I �'� � '" r>Le Intended use of property: i Qqr, (,Z� 7
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
K_ 40 this property? ❑YesOo IF YES, PROVIDE A COPY.
heck Box After Reding: 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 Lbrint name): 6t�n a Authorized Agent ❑Owner
Signature of Applicant: Date: q)31 3kq
STATE OF NEW YORK)
SS:
COUNTY OF )
vg�k,irl)Lc& 'AR, being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the 4
�Itontractor,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 , 20
Notary Public
VICTORIA A FERREMI
E Public^'State of New York110
moN OIFE6430360OPERTY OWNER alified in Suffolk County Wherthe a I ant Is notthe u n C " IIImission Expires Mar 14, 2026 •� ��.
( pp 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
2
Building a artmgent Aj2gliegtion
AUTHORIZATION
(Where the Applicant is not the Owner)
I, q ._._.residing at 0j Ur
(Print property owner's name) (Mailing A. ess)
do hereby authorizeKa4ri'm-Me-maric,
(Agent)
to apply on my behalf to the
Southold Building Department.
Q-0
0(0 ner's Signa ire (Date)
(Print Owner's Name)
JUN wvn�i
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