HomeMy WebLinkAbout51794-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#: 51794 Date: 04/01/2025
Permission is hereby granted to:
Carol Pilecki
68 Grand St
Brooklyn, NY 11249
To:
install new pool fence enclosure around existing accessory swimming pool as applied for.
Premises Located at:
1465 Brigantine Dr, Southold, NY 11971
SCTM# 79.-4-56
Pursuant to application dated 02/24/2025 and approved by the Building Inspector,
To expire on 04/01/2027.
Contractors:
Required Inspections:
Fees:
Pool Fence $125.00
CO Accessory $100.00
Total $225.00
¢adding Inspector
� � a' TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Fe° Town Hall Annex 54375 Main Road P. O. Box 1179 Southold, NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 https: /www.southoldtownnv,s4o
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only li
°
PERMIT NO., Building Inspector:
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an -
Owners Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY: ;y
Name:C� �, I✓ �L I f SCTM#1000- O
Project Address: , �i IQ 5' j
Phone#: '1 11. ` Email: (�%tt0� be��tr�1�i1 , C-gym
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: U C � 1)l) S-r (Wo K--L U N N Ll ( I 2-A- !
Phone#: C1 I'� CGS U �✓-') C �e �Gt yy) �1 k v (�.
DESIGN PROFESSIONAL INFORMATION:
Name.
Mailing Address
Phone#: Email:
CONTRACTOR INFORMATION:; - -
Name: �vN ( A//V1 l ' =NA/V(0 � C,
Mailing Address: A A�- M A f (k /(05, C fw" 1 '
Phone#: Email:
") - q'r3(oI0
DESCRIPTION OF PROPOSED CONSTRUCTION'
ALLCRep $ ate
❑ ew St
Other ructure�❑Addit o ❑n Iteration ❑1Re alr ❑Demolition Estimd Cost of Project:
�
Will the lot be re-graded? ❑Yes�No ill excess fill be removed from premises? ❑Yes ❑No
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 LINO IF YES, PROVIDE A COPY.
❑Check Box After Reading: 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 an 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): CAIIDL �� �� ❑Authorized Agent bDwner
� J
Signature of Applicant: Date:
CONNPE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01 BU6185050
Qualified in Suffolk County.
COUNTY OF ) Commission Expires April 14,
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 C(A(/UiL . , 20a�
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
tl 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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