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Home My WebLink About51696-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#: 51696 Date: 02/28/2025 Permission is hereby granted to: Head of Harbor LI LLC 2631 Merrick Rd Bellmore, NY 11710 To: Construct an inground swimming pool accessory to an existing single-family dwelling as applied for. Pool and pool equipment must maintain minimum side and rear yard setbacks of 25 feet. Premises Located at: 19620 Soundview Ave, Southold, NY 11971 SCTM#51.-3-12.3 Pursuant to application dated 01/21/2025 and approved by the Building Inspector. To expire on 02/28/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 Building Inspector R'gym tt� r t � 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 tittps://www.soutlioldtownny.g-ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only kIL PERMIT NO. I Building Inspector: �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 Owner's Authorization form(Page 2)shall be completed. Date: 1 17 --10 OWNER(S)OF PROPERTY: Name:.JJeQC( �I,Q � Y " �� LL C SCTM# 1000- �" — r , -J Project Address: M 6 Zo soct ociV e'" Av-e, S Add N Phone#: — Z� — J� Email: �— fi N')� 4-0 L • �� Mailing Address: �� QjX ?j�� j N Y ( �S CONTACT PERSON: Name: 1)41 U EL Mailing Address: PC I �� S , Phone#: DESIGN PROFESSIONAL INFORMATION: Name: Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: sew C ( 10015 T hG Mailing Address: .11-1" c UN,+ y T S14, c, � N 1 1 7 (! 9 Phone#: Email:31 3 �a � Cr 411 Pi s w� �l, c�►� DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost o f Project: Other =n t VtiiJNc� 5 -,"r�+n-)n+" oa I�� 1 0D � Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? es ONO 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? Dyes ONO IF YES, PROVIDE A COPY. ❑ Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and stone 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): " LA- O ❑Authorized Agent MOwner Signature of Applicant: ^°� .� � Date: STATE OF NEW YO COUNTY OF m W 1Ndtt,V, being duly sworn, deposes and says that(s)he is the applicant (Name of individual signing contract)above named, (S)he is the �l a (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 J{�N(�(�4 ,/ , 2p 2,L2 Notary Public JAOWICA,ACMESMABC AI Notary Public . 'Slate of New York No. fp1GJLOO19699 �'�� P NEB n� 1 11 V my Comm. Expires 1f11 028 (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 2 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? Dyes ❑No IF YES, PROVIDE A COPY. Check Box After 116ading: 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 misdemeanorpu rsuant to Section 210.45 of the New York State Penal Law. Arckae Application Submitted By(print name): or y ❑Authorized Agent L1dOwner i Signature of Applicant: , Date: l /1?12-)— STATE OF NEW YO COUNTY OF ^ 'V o ,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. i Sworn before me this day of � m ,20 � Notary Public Notary Public �l f Now York ft.0101.00I9E99, 1 -PROPERTY OWNER ALMHORIZATION Qualified In$ulfelk Couny Comm.Expires Jan, 10,2028 (Where the applicant is not the owner) �r� I V( UL60 residing at do hereby authorize to apply on f; my b ehalto the Town of boutholdtl ui ding Department for approval as described herein. F _ r ? s Own II I er's Signature Date Print Owner's Name i 2 i d-� 5JFFQ ID) Scott A. Russel SUPERVISOR AWA1�A�Gr�EI�� IE1�T SOUTHOLD TOWN HALL-P.oi69) 1179 0 Town of Southold 53095 Main Road-SOUT$OLL3,NEW YORK 11971 CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM ,i ( APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT f ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER. APPLICANT: (Property t p y Owner, Design Professional, Agent, Cont cttr Other) NAME: C.h �,; � Date: Contact Information: IL-Mad& Ielephnne Numhe,l Pro- ert Address / Location of Construction Site: t o Sit.. S_C.T.M. #: 1000 District 1` Section Block to 4�1. � c�lrr W O�.MPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT ® - Area of Disturbance rs less than I Acre No S.P D E.S. Permit is Re uired l ` Project does Not Discharge to Waters of the State. No ,P,D.E,S. Permit v; Re aired 0 - Area of Disturbance is Greater than I Acre &Storm-water Runoff Discharges Directly to Waters of the State of New DEC Prior THE H s oncLICANT e c f a Bui diMUST OBTAIN a S.P.D.E.S. Permit DIRECTLY From N.Y.S. \rca of Disturbance is Greater than I Acre,& Storm-�\arPr Rminff Flows Thi'Uuah Southold Town's MS4 Systems to Waters of the State of Nei\ York, THE APPLICANT MUST OBTAIN a S P.D.E.S, Permit throe h the Southold Towtn Er trier°rn De ar tment Pryor to Issuance of a B u ild i 2g Permit, � Rey levved By: Date: F(1RNI CM! P- ' 3r CCCrV4� r� WaE.:x4 Tl# PW�AV1�`.�y�u a o NOV * ESN � pax vxor,,. L „,,,�..."d�•^^"'......�.:-"""'".�.�.�-.W---�Fdm„m ❑ 1� mb ffi Nq m Y o y N �-q Y..1 N LEGEND uGia.n r o xar 1@w ri wew C '� GhNSt#CWF�N rs+rw wee u a 0 a — 0 0 o � a i _ 5 > z n 0 LL z a � 5 0 z 0 i 6. ❑ 5 FOUNDATION AS-BUILT DESCRIBED PROPERTY SITUATE SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY.N.Y„ TAXMAPNO.:1000-051,00.03.00-012„003 w "" LOT AREA:80.03E 20 S,F..(1,837 ACRES) q' DATE SURVEYED:MAY 16.2023 SET STAKES:FEBRUARY 28.2024 SET FOUND.STAKES:MAR..25.,2024 v FOUNDATON AS-BUILT:NOV,15.2024 „CG�"Mtirisy!¢M.kb5'AxptttlfiaWW'l1WNN yj', D�fid;�ygy G CERi10 E0 ONLY TO' �j�' EAO FF7HEHAHBON— ' NONGLLC.ISAOA/ATIMA 11C hA E1 ffN C X' eA v Fu Nm'AesYRA01' COMPANY�.. aLo 6EP❑BUC NATIO x ��«JS,p �— 7q En Feel m � SCALE:111—30 m o B 11 p 143.32 579°25'15W rWILEDBERRYUR°VEP1 ° tJ I waF d mraca Flo , raa� ANE Suffolk County Dept of Labor,Licensing&Consumer Affairs HOME IMPROVEMENT LICENSE Name DAVID KOCIS Business Name SEA CRYSTAL POOLS INC This certifies that the bearer is duly licensed License Number HI-62791 by the County of suffolk issued: 09/09/2019 R054tiR,Dragv- Expires: 09/01/2025 Commissioner This license is the property of Suffolk County se Department of Labor,Licensing&Consumer Affairs. Possession of this license does not guarantee its validity. Additional Business Name License Category H26-Pools and Spas/Certified r'