HomeMy WebLinkAbout51804-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#: 51804 Date: 04/03/2025
Permission is hereby granted to:
Graeb Fmly 2021 Irr Trt
625 Eugenes Rd
Cutchogue, NY 11935
To:
install a new swimming pool barrier with partial deer fencing to an existing single-family dwelling as
applied for. Barrier must comply with 2020 Residential Code of NYS,section R326.
Premises Located at:
625 Eugenes Rd, Cutchogue, NY 11935
SCTM#97.-2-16.2
Pursuant to application dated 02/25/2025 and approved by the Building Inspector.
To expire on 04/03/2027.
Contractors:
Required Inspections:
Fees:
Pool Fence $125.00
CO-RESIDENTIAL $100.00
Total $225.00
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 tt: sa0^ ° w. o a�hl caldtownn .
Date Received
APPLICATION FOR BUILDING PERMIT
i
For Office Use Only ��D ,w I; i
AA
PERMIT NO. POI
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
Owner's Authorization form(Page 2)shall be completed.
Date: FE6 2-.5' 207_
OWNER(S)OF PROPERTY: 4�AKLL`tTRLUs'
Name: ,s Oti N 4 Ib( /.,r GsCZ��+3 SCTM #1000- 4 -7 3��9 97,
Project Address. (p2s C(�Q ��� (�l7 G(�i I C L'fOG(�� l
Phone#: �3l"�p�{'3Z�Z, Email: Iq L-)Cs
Mailing Address: (625' t LQ G-61 &-.5; Lk(CL4-0&LAG KA
CONTACT PERSON:
Name: ibVK �CQ
Mailing Address: 6? g E LQ&IE14ES (f"T C H-D t4 � L Q 3 S
Phone#: /031 804 328z Email: Sa-D&77 0&MAI L-a Cc)hg
,
DESIGN PROFESSIONAL INFORMATION:
Name: �U
Mailing Address:
Phone#: Email:.
CONTRACTOR,INFORMATION:
Name: }L3 D
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION -
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
Z I
®Other F�G� .61 t-LElaT- $ "'' v cacao .
Will the lot be re-graded? ❑Yes igNo Will excess fill be removed from premises? ❑Yes (ENo
PROPERTY INFORMATION
Existing use of property: t;je�Sf i 97
-DICE ( FAHIL7 Intended use of property: (z S h�'��
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R�tT>6.tLTj,t�- R-.60 this property? ❑Yes ®No 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 on premises and in building(s)for necessary inspections.False statements made herein are
punishable as a ClassA misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
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Application Submitted By(print name): ❑Authorized Agent NOwner
Signature of Applicant: Date: Z (Z—?
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01 BU6185060
SS: Qualified in Suffolk County
COUNTY OF SUr-r-D LK ) Commission Expires April 14,2 O-
being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the O w m e R
(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
N.
ay of tC 20
Notary Public
PROPERTY OWNER AUTHORIZATION
(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