HomeMy WebLinkAbout51890-Z p 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#: 51890 Date: 04/30/2025
Permission is hereby granted to:
Harry Pantelides
526 E 19th St
Brooklyn, NY 11226
To:
construct accessory sports court as applied for.
Premises Located at:
550 Mt Beulah Ave, Southold, NY 11971
SCTM# 51.-3-2.16
Pursuant to application dated 02/21/2024 and approved by the Building Inspector.
To expire on 04/30/2027.
Contractors:
Required Inspections:
Fees:
Accessory-New Structure $125.00
CO Accessory $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 htt)S:1/v"vw.sowhol ta; Dinyxa
Date Received
APPLICATION FOR BUILDING PERMIT
EC WE
For Office Use Only
g Inspector:-
Building Ins
PERMIT N0. p F F R 2 1 202.4
Applications and forms must be filled out in their entirety. Incomplete v c
applications will not be accepted. Where the App Iicant is not the owner,an
`
Owner's Authorization form(Page 2)shall be completed: Town ePs Souy.SFt id
Date:
O N R( )CIF PROPERTY:
Name:Harry Pantelides
Project Address:550 Mount Beulah Avenue Southold NY 11971
Phone#:917-412-3671 Email:hpantelides@gmail.com
Mailing Address:526 E 19th Street Brooklyn NY 11226
CONTACT�PERSON:
Name:
Mailing Address:
Phone#: Email-,
DESIGN PROFESSIONAL INFORMATION:
Name
Mailing Address; _ 0 Gpvc-r'-A P C*1I
Phone#: —� I" C!-�' c�J�� Email: G�c ' " v d V Vrf"f�".hi
CONTRACTOR INFORMATION.;
Name;
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION , „.
,�fVew Structure ❑ ❑ ❑ ❑ Estimated Cost of Project:
Addition Alteration Repair .Demolition �
Npther ov vch2 SAC UC�t cvviz.'T G ,
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes o
1
PROPERTY INFORMATION
Existing use of property: e Intended use of property: 99-'r, ` a
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
Q JIlk() 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 Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(print name): Harry Pantelides ❑Authorized Agent 1ROwner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF
being duly sworn, deposes and says that(s)he is the applicant
(Name of-ipAividual signing contract) above named,
(S)he is the � e l�
(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 a d-4 20
Notary Public
PROPERTY OWNER AUTHORIZATION �� U7u,VI
(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