HomeMy WebLinkAbout51475-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#: 51475 Date: 12/13/2024
Permission is hereby granted to;
Richard N Kalich
605 Saltaire Way
Mattituck, NY 11952
To:
construct accessory in-ground swimming pool as applied for.
Premises Located at:
605 Saltaire Way, Mattituck, NY 11952
SCTM# 100.4-19
Pursuant to application dated 10/21/2024 and approved by the Building Inspector.
To expire on 12/13/2026.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
41 Total S400.00
Iding 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 lint)s:HwwN .soutioldtowtin, Y v
Date Received
APPLICATION FOR BUILDING PERMIT
MII
For Office Use Only � I IIyIyI I/
PERMIT NO, Building Inspector.
Applications and forms must be filled out in their entirety. Incompletei �u ny r � t
applications will not be accepted. Where the Applicant is not the owner,an roVV
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM # 1000-
Project Address:
Phone ' �, Email:
Mailing Address:
CONTA PERSOI'�.
Name: OWN
Mailing Address: 1;5A
Phone#t Email.
.,)
DESIGN OFE0IONAL INFORMATION:
Name: f s LaPwioo,
Mailing Address: �kffi r)s—
Phoin #031 Email:
CONTRACTOR INFORMATION-
Name
:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
pair ❑Demolition ' Estim crs��Pe
❑New Struct I� $
;Other tion ❑Re
ure ❑A dition ❑Alters
Will the lot lbe re-graded? ❑Yes No Will cessfill be removed from premi�es
I
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? ❑Ye o IF YES, PROVIDE A COPY.
Check Box After Reading: The owner/contractor/design professional is responsible for all d' Inae and storm water issues as provided by
C tear 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
Orden ce 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 210.4S of the New York State Penal Law.
Application Submitted By( i name : 1)4 utlori2ed Agent El Owner
Signature of Applicant: Date: Ao121
1�
STATE OF NEW YORK)
SS:
COUNTY OFP-4Q AJ A I k:ZkZ&�)
being duly sworn, deposes and says that(s)he is the applicant
(11ame of individ a 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 applicatio rel i q to the best of his,/her knowledge and belief; and
that the work will be performed in the manner set fort,�I : k , 'I + Lin file therewith..
: 0.0111 152 1657"; � t
Sworn before me this QUALIFIED 1�
.. ;s Fol K COu1�1Ty
day of ,2 ": tt-29. .
vs + Not ry Public
�Ip ti�,
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
1, Ma fQ residing at
do hereby authorizeA Ytap ply on
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my b�e�alf to the Town of Southold Building De, la1�m 944ftz"proval as described herein.
.col A ZK
:1o.01 M 162 3165 7
O 'er's ignature oUALIFIED M Date
SUFFOI. COUNTY
Comm. o .
� G 11-26
Prin. Owner s Name �'�"��� .
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SURVEY TOR
THOMAS A. ER a DEBRA N. FLAD R
LOT 22
49SALTAiRE ESTATES` , e
MATTITUCK r
TOWN OF SOUTHOLD
SUFF. CO., N.Y. ' ' NOTE i
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