HomeMy WebLinkAbout52595-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, NY
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES
WITH ONE SET OFAPPROVED PLANS AND SPECIFICATIONS,
UNTIL FULL COMPLETION OF THE WORK AUTHORIZED)
Permit#: 52595 Date: 01/06/2026
Permission is hereby granted to:
Robert Thomson
43 Willis Ave
Floral Park, NY 11001
To:
Construct an inground swimming pool accessory to a single-family dwelling as applied for. Pool and
pool equipment must maintain a minimum side and rear yard setback of 5 feet.
Premises Located at:
675 Pine Tree Rd, Cutchogue, NY 11935
'' CTM# 104.-1-6
Pursuant to application dated 11/13/2025 and approved by the Building Inspector.
To expire on 01/06/2028.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total $400.00
Building Inspector
&VȢ aMd
w
µ TO OF SOUTHOLD_BUILDING; DEPARTMENT
��� � w NY 11971-0959
Town Hall Annex 54375 Main Read P. 0. Box 1179 Southold,
Telephone (631) 765-1 0 Fax (631) 765-9502IT
sg �t t
Cute Received
PIP 11 ATIDN FOR BUILDING
PERMIT
For Office Use Only
iu
q5
w
ct 4 .
Bui
lding Ins w°
PEaMI1`i11�J.5- g � 1
Applications and forms must he filled out in their entirety. Incomplete
applications will not be accepted. 'Where the Applicant is not the owner,an
ow►nees Authorization form(Page 2)shall he completed.
Date: -�
OWNER(S)OF PROPERTY:
Name: In SCTM# 1000--
,- a.IJ 1�1-
OWN
Project Address
r
Pho
ne#
• w Email,
r 'w++n�
Mailing A dr ss?�
CONTACT PERSON:
Narne� 0' rar" 1&�
S
Mailing Address: 'C) k.."I
--------------
Phone#: Email1�
V
DESIGN PROFESSIONAL INFORMATION:
z
Name,
Mailing Address:
Phone#: Email s .
CONTRACTOR INFORMATION:
Namesy
Q
Mailing Address ro
Y .
Phone#: 09 -'14) ZO
man: La,
DESCRIPTION OF PROPOSED D CONSTRUCTION
_New Structure E-lAddltion ❑Alteration E3Repair RDemolition Estimated Cost of Project
❑Other ,
Will the lot he re-graded? es C Na Will excess fill he removed from premises? ❑Yes 0
PROPERTY INFORMATION
. � , intended use of property.&-2� —d—e
Existing use of property.
district in which remises is situated: Are there any covenants and restrictions with respect to
WHO
Zone or used p
this property? ❑Yes No IF YES, PROVIDE A COPY.
C9 he!c fox After Reading: The owrnerr/contractor/devign 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 wilding Department for the issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Sufffolk,,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 node and regulations and to admit authorized Inspectors on premises and In building{s)for necessary Inspections.False statements made herein are
punishable as a Clasi A misdemeanor pursuant to Section WAS of the New York State Pena
P01 rppCL,
t..�l l
Application Submitted By ��CU
Authorized,Agent C3 Owner
pp
Signature of A c ntt" � �� Gate.
/ .
STATE OF NEW YORK)
SMr
COUNTY0F
,r
�- 0(16 bein dui sworn dep
oses and says
s th
at(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;
lication•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
Iiwiijiim
ay of1 _
of ry Public
m
LINDSAY NADRAMIA
Notary Public-state of New YorkPROPERTY OWNER AUTHORIZATION
r
No. 01 NA0018896
Qualified in Suffolk County (Where the applicant is not the owner)
Mv Commission Expires Dec 19,2027
13 ' v r
FL
1 mj V!n- 0n residing at
M
' ► "eti t apply on
do hereby authorize
rnY behalf to the Town of Southold Building Department for approval as described herein.
� a
Owner's Signature Date
Print Owner's Name
2