HomeMy WebLinkAbout52309-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#: 52309 Date: 10/01/2025
Permission is hereby granted to:
Amy Herzig
216 St Johns PI Apt B
Brooklyn, NY 11217
To:
Install in-ground swimming pool at existing single family dwelling as applied for.
Maintain minimum 10 feet setback from side and rear property lines to pool and associated
equipment.
Premises Located at:
675 Orchard St, Orient, NY 11957
SCTM# 25.-2-16.7
Pursuant to application dated 08/22/2025 and approved by the Building Inspector.
To expire on 10/01/2027.
Contractors:
Required Inspections:
Fees:
CO Single Family Dwelling-New $100.00
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
Total S400.00
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 litt,os�://www.sotit,lioldtownnyXov
Date Received
APPLICATION FOR BUILDING PERMIT E C E 0 V E
D 'i
For Office Use Only
LI G 2 2 2025
PERMIT NO. 13 01 Building Inspector:
Bullding Department
Applications and forms must be filled out in their entirety. Incomplete Town of Southold
applications will not be accepted. Where the Applicant Is not the owner,an
Owner's Authorization form(Page 2)shall be completed.
Date: 1
OWNER(S) OF PROPERTY:
Name: YYI I" SCTM#1000- - _ _
Project Address:
f ) v-
Phone#: _ (�� Email:
Mailing Address:
CONTACT PERSON:
Name:
Mailing Address: N
Phone#: Email: i
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: 22
Jml-s xi
Mailing Address: N,A qqa
Phone#: 1_q _-� s Email: 1 S
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
[A)ther �mi $ 101 &00
Will the lot be re-graded? ❑Yes I�Vo Will excess fill be removed from premises?;J4s [:]No
1
PROPERTY INFORMATION
Existing use of property:'ak" iF(Ck le Djjt\k Intended use of property:aS)DN ame-
(li wI Sw%Mw'"
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
L4 o this property? ❑Yes o IF YES, PROVIDE A COPY.
❑ Clieck 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): CQ 1W, 0 authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTYOF Su- /K )
KCA�/'r`n q A4 ��� `'r�',v being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)) above named,J(S)he is the cA e/,,
(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
I,.
day of �y J �- 2025
Notary Public
ANDREW BA AL
Notary Public, State of New York
No.MA6395436
1:��114"°�� IIG I�,;R OWNER UT I,,,1 I1 I "I I y C¢ajur� I Expires d in surfoik county ��
.. jj-� es Jul 29,
(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
Building Department Application
AUTHORIZATION
(Where the Applicant is not the Owner)
I Q,/'Z� residing at (4 6 S o ri Q W f I' 9
(Print perry own s name) (Mailing Address)
Y �ct�n,n do hereb authorize a
(Agent)
Me—v 0—U YX 0 to apply on my behalf to the
Southold Building Department.
6
(OwneWS 'i;nature)JI
ate)
Print Owner's ame
-
S.C.T.M. NO. DISTRICT: 1000 SECTION: 25 BLOCK: 2 LOT(S):16.7
LAND N
OF
NADA PIMMVAIA
OAWL WATTS
"'� S u'S7'10•E 6902 TLT
- 7&4V( pjf► )
LAND N/F
OF
LEONARDO PAROL,
E+UMA 1RENTI PAROL,
OS
LAND N/F
I of
(V —` a EDWARD HEALY
I
,t a
d SPY
LAID N/F
of
MARK KAFFAGA
W �D
.do.o•
•�. ?JF!'TRY, 101'
Laa:R.t
Qi
.}
tmo a
52 7.93'
rvr
auir1.
ORCHARD STREET
UP. 0
IN£ WATER SUPPLY, VIELLS. DRYKELLS AND CESSPOOL
LOCA BONS SHORN ARE FROM FIELD OBSERVA(IONS
AND OR DATA OBTAINED FROM OTHERS
AREA: 22.505.83 SOFT. or 0.52 ACRES Eft EVAWV DATUM: -----------—____---_---
UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW COPIES OF THIS SURVEY
MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN
ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION
LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION. OUARANTEES ARE NOT TRANSFERABLE.
THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECInC PURPOSE AND USE THEREFORE THEY ARE
NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE TN£ ERECTION OF FVVCES� ADDITIONAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS
AND/OR SUBSURFACE STRUCTIJRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME Or SURVEY
SURVEY OF: DESCRIBED PROPERTY CERTIFIED TO: AMY HERZIG;
MAP OF: FIDELITY NATIONAL TITLE INSURANCE COMPANY;
FILED:
SITUATED AT:ORIENT
Tom OF:SOUTHOLD KENNETH M NOYCHUK LAND SURVEYING, PLLC
SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design
P.O. Box 153 Aquebogue, New York 11931
FILE / 18-160 SCALE:1"=30' DATE:DEC. 17, 2018 PHDNE (e31)M-I588 FAX (631) 211E-OWS
N.YS LISC. NO. 050882 mldataISKlns tea CCON of R"CFt J. NGUM W N Kanaath M. 1lnrehae