HomeMy WebLinkAbout52472-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
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#: 52472 ' Date: 11/19/2025
Permission is hereby granted to:
Erick Haas
1265 Park Ave
Mattituck, NY 11952
To:
construct an accessory in-ground swimming pool as applied for.
Premises Located at:
1265 Park Ave, Mattituck, NY 11952
SCTM# 121-2-28
Pursuant to application dated 10/08/2025 and approved by the Building Inspector.
To expire on 11/19/2027.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total $400.00
Building Inspector
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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 s://www.sout�holdtownily.g
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. � Building Inspect�ar:
Ili)
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant Is not the owner,an Building De arb-ne nt
Owner's Authorization form(Page 2)shall be completed. Town o
Date: 14
OWNER(S)OF PROPERTY:
Name:Cr1�-- d ( SCTM#1000 /Z3
Project Address: ��k/ 4� ���/' //Ss
Phone#: &3 f, 9-3,5-- -X7tZ e-�'c'n5 ce7 r»cc.'1.exi-il
Mailing Address:
CONTACT PERSON:
Name: 4d�h,e-
Mailing Address: —?
Phone#: Lo3j -73�/—�I.�GS Email:��,'� IJK�O�'j �� n� ,n e�
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: n-�tV0V_Mailing Address:,-?.
Phone#: Lo31 -73`�'7�0(95 Email: c�L'}„�c�l<o�61- c�n�'�ne , n e
DESCRIPTION OF PROPOSED CONSTRUCTION
[]New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
>'bther
- $ ;:?;7
Will the lot be re-graded? )6es [:]No Will excess fill be removed from premises? ❑Yes LK0
1
PROPERTY INFORMATION
Existing use of property:j !�4" Intended use 'f property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes %Ko IF YES, PROVIDE A COPY.
XCh ck Box After Reading: The owner/contractor/design professlonai 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 B ri name : " � ;AA authorized Agent ❑Owner
P P Y(P ) ", �� g
Signature of Applicant: Date:
' d IE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified In Suffolk County
COUNTY OF ) Commission Expires April '14,20
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(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 W I ,�^
day of O C�t't�'i�—��.... , 20 6—en 1`> A
6/1
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
i, Vl residing at . ' ... 11"I52
do hereby authorize + to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
I o V10
Own Signature Date
3dc_,C A n kAgc,4 S
Print Owner's Name
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SMiA TM AT- MATTITUCK
SUF FOLK OUvi TY, N.'EW YOr` K Prof ssiohat Laud Surveying+gad ,fie
P.O. Box 153 Aq tebogue. New York 1193t
Ft:+� # 1.3-72 5th1.E. I"-3G` DATE, MAY 7, 2011
PHONE (a�r.j�-1S$6 PAX (e3�1) M-1586
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