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HomeMy WebLinkAbout51702-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#: 51702 Date: 03/03/2025 Permission is hereby granted to: Friedman Henry P Liv Trust PO BOX 1868 Apopka, FL 32712 To: Construct an inground swimming pool as applied for. Pool and pool equipment must maintain minimum side and rear yard setbacks of 5 feet. Premises Located at: 295 Grange Rd, Southold, NY 11971 SCTM#78.4-4 Pursuant to application dated 01/23/2025 and approved by the Building Inspector, To expire on 03/03/2027. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 Building Inspector s � TOWN OF SOUTHOLD—BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959 w � � Telephone (631) 765-1802 Fax (631) 765-95021°att,as;//wv. taut,holdtwwnn . ov Date Received APPLICATION FOR BUILDING PERMIT For Office Use Only PERMIT NO. V Building Inspector:, 2( 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: OWNER(S)OF PROPERTY: Name: M St SCTM#1000- ) d p 7 Project Address: Phone#: � V1 Email: Mailing Address: 110 ,S. rt VF P r` q w CONTACT PERSON: Name: PnA R 1 1*-rqlVA A k4 G° „�► II Mailing Address: 110 S�u y,o� o+t �F• J LA t )J Phone#: V a Email: DESIGN PROFESSIONAL INFORMATION: Name: o 4- I—� I ►, Mailing Address: a H l 0� " �l l Phone#: '�1 © '�� S Email: R A�Gl� I o '� �, - L o " CONTRACTOR INFORMATION: Name: tt ^y J Mailing Address: a [--,ran . I h A � � �- o G l v 1 • z Phone#: ( Email: 0 1k DESCRIPTION OF PROPOSED CONSTRUCTION New Struc re ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project: Other ��� Sr, i ti ., ► $ 2� `' '3 J Will the lot be re-graded? ❑Yes 1,kNo Will excess fill be removed from premises? ❑Yes )�Vo 1 PROPERTY INFORMATION Existing use of property: \p� Intended use of property: I ,� I � S �- Pti � 01 Zone or use district in which premises is situated: Are there any covenantand restrictions with respect to this property? ❑Yeso IF YES, PROVIDE A COPY. C(Cheick I'lox After Reading: The owner/contractor/design professional Is resporWble for all drainage and storm water Issues as provided by Chapter 236 of the Town Code. APPUCATION 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 bullding(s)for necessary inspections.False statements made herein are punishable as a pass A misdemeanor pursuant to Section 210.45 of the New York State Penal taw. Application Submitted By(p rL a 19 N r► A L s , ❑Authorized Agent tgowner Signature of Applicant: Date: STATE OF NEW YORK) SI COUNTY OF s�' I`I�l � being duly sworn, deposes and says that (s)he is the applicant (Name of individual signing contract) above named, (S)he is the �W 4—"Y (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 �Gt� Va 20 Notary Public Kristina A Fuller ^I Notary No01 FUtate of 5w York II �VIII III II I � �I; m' ) IIIIIIII Public, (Where the applicant is not the owner) Qualified in Suffolk County My Co ri'lle lon Expires April 17,2025 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