HomeMy WebLinkAbout52502-Z fID) 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#: 52502 Date: 12/02/2025
Permission is hereby granted to:
Sean Southard
28 Bayview Ave
Port Washington,NY 11050
To:
Legalize an "as built" above ground swimming pool accessory to an existing single-family dwelling as
applied for. Pool and pool equipment must maintain rear and side yard setbacks of 15 feet.
Premises Located at:
730 Sebastians Cove Rd, Mattituck, NY 11952
SCTM# 100.-3-11.6
Pursuant to application dated 10/22/2025 and approved by the Building Inspector.
To expire on 12/02/2027.
Contractors:
Required Inspections:
Fees:
As Built Pool/Hot Tub $600.00
CO Swimming Pool $100.00
Total 700,00
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 htt.s:I/w%vw.soutlio cltownn .
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only ` "' rl-
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PERMIT NO. O Building Inspector:
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Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an en r Un"C'M
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM # 1000-
C?aV, 0
Project Address: .73 CJ0CCcS T d&f//S CC Le, CiG
Phone#: � 6r 7_ , Email: 550 +f) Ave
Mailing Address: OZ� Illetv Fo r- 1+ f
CONTACT PERSON: �c
Name: SPr t ��'v�
Mailing Address:.
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑NPwStru ttare � ❑Alteration ❑R epairp❑ e olition Estimated Cost of Project:
l�Other ❑AdditionD $
Will the lot be re-graded? ❑Yes ❑No Will excess fill be removed from premises? ❑Yes ONO
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PROPERTY INFORMATION
Existing use of property: tpw/h 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.
❑ Check BOX After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 736 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 oftheTown 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 W admit authoraed inspe":tors on premises and in buildmg(s)for necess2ry inspections.False3taterrieMs"made herein are
punishable as a etass A misdemeanor;pursuant to Section 2i0As of the New;York State Penal Law " "
Application Submitted B (print name : Sew ❑Authorized Agent Owner
PP Y(P ) g
Signature of Applicant: Date: /p
BUNCH DC,�
Notary Public, to of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified in Suffolk County
COUNTY OF i Commission Expires April 14,2��
Seams S3() V"k 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
day of M _ 20 /ti.� � 61A,
Notary Public
PROPERTY OWNER AUTHORIZATION
(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
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