HomeMy WebLinkAbout52103-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#: 52103 Date: 07/15/2025
Permission is hereby granted to:
Tigran Navasardian
145 W 67th St Apt 28c
New York, NY 10023
To:
Construct an inground swimming pool accessory to an existing single-family dwelling as applied for.
Pool and pool equipment must maintain a minimum side and rear setback of 10 feet.
Premises Located at:
300 Little Peconic Bay Ln, Southold, NY 11971
SCTM#88.-6-13.34
Pursuant to application dated 06/24/2025 and approved by the Building Inspector,.
To expire on 07/15/2027.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total $400.00
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 httt)s://www.soutboldtownny.go
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. I O ✓ Building lnspector
V
Applications and forms must be filled out in their entirety.Incomplete JUN P. 4 2025 �
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
ialln ep.—. I
.Town Of
Date:
OWNER(S)OF PROPERTY:
Name: �` • ' - � SCTM # 1000- — (07
Project Address:
s
Phone#: .�.
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: LA/
J
Phone#: " 1 " `7 Email:
DESIGN PROFESSIONAL INFORMATION:
Nara
Mailing Address:°
Phone#: �y (. Email:
CONTRACTOR INFORMATION: L
Name: )
bg
Mailing Address: --71 A 1?�
Phone#: r ri 11qq-- Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑d iti n ❑Alteration ❑Repair ❑Demolition Estimated Cost of�Soi-qe
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑YesIo
1
PROPERTY INFORMATION
Existing use of property: Intended use of property;
Zone or use district in which premises is situated: Are there any covena is and restrictions with respect to
this property? ❑Yes IF YES, PROVIDE A COPY.
PlleC' O After eading: The owner/contractor/design professional is responsible for all dra age and storm water issues as provided by
or236 ofthe TownCode. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone
anc 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): l L]Al rized Agent r
4va_a4
y .
Signature of Applicant:
STATE OF NEW YORK)
SS: _
•�;� yip• ��", Y
COUNTY OF ) "� Z
P"
, Q being duly sworn 'dhat(s)he is the applicant
(Na ndlvldual signing contract)above named, "/nnlllw\0
(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
fFgday of
Nota Public
PROPERTY OWNER AUTIIONIZATION
(Where the applicant is not the owner)
� r
Ll
I, i d i n g at �_j ifl,
do hereby authorize )Vv �46Qto apply on
my be to th n outhold Building Department for approval as described herei
��L�yp��t4C11E
Owner's Signature` Date
Print Owner's Name oY
° r I
���/IlyaggrylllAAA"o