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HomeMy WebLinkAbout52794-Z TOWN OF SOUTHOLD o BUILDING DEPARTMENT SOUTHOLD, NY BUILDING PERMIT (THIS PERMIT MUST BE KEPT CAN THE PREMISES WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permit#: 52794 Date: 03/27/2026 Permission is hereby granted to: Randolph J Polyn 2900 Grand Ave Mattituck, NY 11952 To: Construct an inground swimming pool accessory to an existing single-family dwelling as applied for. Pool and pool equipment require a minimum side and rear setback of 10 feet. Premises Located at: 3000 Grand Ave, Mattituck, NY 11952 SCTM# 107.-2-6 Pursuant to application dated 03/09/2026 and approved by the Building Inspector. To expire on 03/26/2028. Contractors: Required Inspections: Fees: SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00 CO Swimming Pool $100.00 Total $400.00 Building Inspector p„wu N � r wri F oITTI3oL1�►—BUILDING DEPARTMENT TOWNTown Hall Annex 54 375 Main Road P. 0. o: 1179 Southold,NY 11971 0959 l 75-9502 � � .� ulto1 �V Tele hone (63 1) 7 5--1 02 Fay ► M a � u � u Date Received APPLICATION FOR BUILDING PERMIT VI d' For office Use Only PERMIT NCB VBuilding l s e tt r� f ' A)l Applications and forms must be filled out in their entirety.Incomplete VI not the owner,a ted Where the Applicant is re app�licationswiii�n�tbe accepted. � � � �� � beom Ieted�� owners,Aut,h ation form( "age Date: -, CP --- ------- OWNER(S)OF PROPERTY: Name:, ,( SCTM#10C10- _ a . I Project Address. "0 Phone#: Email: 00000 3 • • • ess. Addr �� Mal 0 lrng CONTACT PERSON: Name: W I Mailing Address: L yl Email: Phone#`U3, ), %�I�fDESIGN PROFESSIONAL INFORMATION: Name: Mg ailin Address.' ' M40 .................T_Y mom" Phone �� � Email: CONTRACTOR INFORMATION: Name Mailing Address #: Email: Phone DESCRIPTION OF PROPOSED CONSTRUCTION New Structure ©Addition ❑Alteration []Repair D D emolition Estimated Cast of Project: D Other WHOR + Will excess fill be removed from premises? DYes No Wi I the lot be re-graded?/EYes E]No PROPERTY I N FOR MAT1 ON Existing use of property: Intended use of property: ... Zone or use district in which premises is situated Are there any covenants and restrictions with respect to this property' DYes ❑No IF YES,,PROVIDE A COPY. oil, limp"41 Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and stomp water hmm as provided by ptar 236 of the"fawn Cade.APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zane Winance of the Town of Southold,Suffolk,county,New Mork and other applicable laws,Ordinances or ReBulatlons,fbr the construction of builder,, addition s,alterations or for removal or demolition as herein described.The applicant agrees to comply with A applicable laws,ordinances,bulldit code, housing code and regubdons and to admit authorized inspectors on premises and in building(s)for necessary Inspections.False stamrnen'ts made herein are punishable asa class A misdemeanor pursuant to section 210.45 of the New York State Penal Law. n Submitted n ararnount Development group, Inc. IMAuthorized Agent 130wner Applicativ '" Date: Signature of Applican, STATE OF NEW YORK) SS: COUNTY OF SUFFOLK,. u , being Y dui 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.) owner or owners and is duly authorized to perform or have performed the said work and to make and file this of said w , Y 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 z ay d of � .. Notary µ � Public", "Wtirm: u iic f LIND6AY NADRAMIA Notary Public-Stone of New York No.01 NA 1 ss96 PROPERTY WNE VI TIO Qualifled in Suffolk County my Con,Mission Expires Der-19,2027 (Where the applicant is not the owner) Randolph J.PoI b Asaf A. German as ,gent I, P residing,at 1 26 `Fo 1 uc venue We6ki Wachee Florida, 34613 paramount Development Group Inc. do hereby authorize �` to apply an f to a of South Buil In a artment for approval as described hereini e a� Date Owne nature Sworn before me this Randol h J.pal b Asaf A- German as Agent day of µ Print Owners Name 2 a h1�. SHARON RADONIS Notary Public-State of New Yo r k NO.01 RA617963+6 Qualigaj in guffolk County