HomeMy WebLinkAbout52114-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
�courrtr,
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#: 52114 Date: 07/18/2025
Permission is hereby granted to:
Reem A Batarseh
19 Dutch St Apt 43B
New York, NY 10038
To:
Construct an inground swimming pool accessory to an existing single-family dwelling as applied for.
Pool and pool equipment must maintain minimum side and rear yard setbacks of 5 feet.
Premises Located at:
5950 N Bayview Rd, Southold, NY 11971
SCTM#79.-2-9
Pursuant to application dated 06/26/2025 and approved by the Building Inspector.
To expire on 07/18/2027.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total $400.00
Building Inspector
IR".rd'er:rtrx
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 l'ittDs://www.souttioldtownU.gov
Date Received
APPLICATION FOR BUILDING PERMIT E C E 0 V E
For Office Use Only
PERMIT N0. I Building Inspector; JU
Applications and forms must be filled out in their entirety.Incomplete Building Department
applications will not be accepted, Where the Applicant Is not,ihe°owner,an Town of Southold
Owner's`Authotiiation'form(Page 2)shall be completed.
Date: CX Zb Z-'5-
OWNERS)OF PROPERTY:
Name: � SCTM#1000-'�;y ._
Project Address: �� v� old, /V Y //9;7
Phone#: �S/�o -���-.��33 Email: tnelto �W Qvl- C.v.•Y-7
Mailing Address: j 95V
CONTACTPERSON:
Name: e-n e-
Mailing Address: C 7C), 'Bois 9, �c��c,��c; , iV�l' I/93.j
Phone#. (�3l ,iegY `/Z J Email:ACI-);k-,k a-p+Oni;n e. ne,4
DESIGN PROFESSIONAL,/INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:eD,i•lK f Ld s L4-c—k -
Mailing Addressr-?ej, )x A),4,"' /J93S
Phone#: Email:schI Cn -fIe ne;+
DESCRIPTION OF PROPOSED CONSTRUCTION
El New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
J'Other '�tav� $
Will the lot be re-graded? Xyes ❑No Will excess fill be removed from premises? ;Wes ❑No
1
PROPERTY INFORMATION
Existing use of property: /-41 F' Intended use of property; '
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? [--]Yes No IF YES, PROVIDE A COPY.
1 kNefaralldrinageo and storm water Issues as proqdii0y
et�" tfN o cf , " fI 1P hldAMfo tern Building pertr"Intfortote issuance of 04jiding Permit punuafit to the Building zone
Or nance of the Town of Southold;"Suffolk,Coi`e�nEy,New York and other applicable laws ordinances or Regulations,for the construction of buildings,
Vol,B o N Nter tioc 0,f ot"f"emg/rsl Or dem4i_,
a 1l0l l►t trloett p'tlpNi pt a to" 1plti`1 dof t 010 laws ordinances,building code.
� Lrkou w1ffwio biwlldl kf r�c � hp � wfalssstate71
ents made herein are
r her,
un � �� ��f � Y" ate�aa � �
Application Submitted By(plri t name): 47el-tle- ���( eAuthorized Agent ❑Owner
Signature of Applicant: Date: —
STATE OF NEW YORK) CONNIC D. BUNCH
SS: Notary Public,Stale of New York
COUNTY OF ) No,01BU 6 18:5050
Qualified in Suffolk County
Commission Expires April 14, 2.�....m
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the re'
(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
L 0
day of (.y`-�_ zo_�S C�
Notary Public
PROPERTY OWNER, AUTHORIZATION
(Where the applicant is not the owner)
I residing at
do hereby authorize i 4-ck `P&J5 /Wc , to apply on
my behalf to the To o lold Buildin epartment for approval as described herein.
Own i u e Date
Print wner's Name
2
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