HomeMy WebLinkAbout52962-Z TOWN OE SOUTHOLD
� e
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#: 52962 Date: 05/08/2026
Permission is hereby granted to:
Harvey Marchbein
125 Country Club Dr
Port Washington, NY 11050
To:
install a hot tub as applied for. Must maintain a minimum setback of 10'from lot lines.
Premises Located at:
15305 New Suffolk Ave, New Suffolk, NY 11956
SCTM# 117.-6-15
Pursuant to application dated 04/29/2026 and approved by the Building Inspector.
To expire on 05/07/2028.
Contractors:
Required Inspections:
FOOTING/REBAR, ELECTRICAL- ROUGH, ELECTRICAL- FINAL, DRAINAGE, FINAL,
Fees:
SWIMMING POOLS-ABOVE-GROUND WITH REQUIRED FENCING $300.00
CO Swimming pool $100.00
Total $400.00
.6 Aww
uif,fidi ng Inspector
TOWN OF SOUTHOLD--BUILDING DEPARTMENT
Town Hall Annex 54375 :Main Road P. 0. Box 1179 Southold,NY 11971-0959
r
` Telephone +631 765 1802 Fax 631 765-9502
1 f'
Date Received
APPLICATION FOR BUILDING PERMIT
For office Use Only0?
PERMIT NO., Building Inspector.,-
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2):shall be completed.
Date:
OWN ER(S)of PROPERTY:
Name: OA SCTM# 1000- -- �,-
Pro�ec; res,
�.
Phone#: i _ w Email: vVNrZC—h6ce) +c�LrNC- Nc"
Mai'ling Address �; �. r (q(AS', 1, 05.6
CONTACT PERSON:
Name:
Mailing Address: '
EmaiI.:
Phne#: to ng to
o J _,
DESIGN PROFESSIONAL.INFORMATION:
Je'l L Name:
r�tvy�'C; - - i'y�, �,..�"�' .��r+►" C�'�:"—"
Mailing Address:
Phone J Email:qq., - , - lawrke"',
CONTRACTOR INFORMATION:
Mailing Address; �. t ►. 'v -�i c
Phone# i— , ►- - `?-. Email: �
s chic., s ,
= ` c
DESCRIPTION of PROPOSED CONSTRICTION
❑New Structure ❑Addition C-IAlteration ❑Repair ❑Demolition Estimated Cost of Project.
ther
......................
Will he lot be re-graded? ❑Yes" o Will excess fill be removed from premises? ❑Yes A'
,No
IN i g t
1
........................
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district i'n which premises is situated: Are there any coveriants,and restrictions with res,ped to
this property? ❑yesxft IF YES, PROVIDE A COPY.,
C!fCheck Box After R,e�a,ding:, The ownar/contractor/design professional is responsible for a�lldrainage and storni�water as proidded by
Cha pter 2316 of the"Town Cod e., APPLI CATION IS flyESYMADE to the Bui I'd Ing De partment for the issuance of'a Building Perm it pursuant to,the Building Zone
Ordinance o f the Town of Southold,Suffolk,County,,New'Yotk,and other applicable Laws,Ordinances,or Regulations,,'for the construction 0b,uild'Ings,
additions, alterations,or for removal or d ern olition as here,I in described.The,applitaint agjv es to com
, ply with a41,applicable laws,,ordirtances,buildingcode
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): ElAuthorized Agent Ow ne r
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF
C-5 1 C Il(A Ratrak,6"itl 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.
11
Sworn before me this
day of t)ri 1 20
Notary Public
PROPERTY OWNER AUTHORIZATION ANITA ELIZABETH GUAMAN
wo I Notary Public-State of New York
(Where the applicant is not the owner) No.01 GUO01 3842
Qualified in Nassau County
My Commission Expires 09/27/2027
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
—-------------
r i0'r"log �9 w;�
BUILDING DEPARTMENT Electrical Inspector
TOWN OF SOUTHOLD
Town Hall Annex - 54375 Main Road - PO Box 1179
Southold, New York 11971-0959
a-+ ,
Telephone (631) 765-1802
APPLICATION FOR ELECTRICAL INSPECTION
ELECTRICIAN INFORMATION (All information Required) Date-
Com an Name: M��� fj- cckx-(� .
Company
Electrician's Name°: � o Lten par i
License No. -- 0 14 EIec. email:; i+cktr' a c -JraC_+V1 e t I CO rr,,
Elec. Phone No: 1,L- 4 - 3 ❑I request an email copy of Certificate of Compliance
Elec. Address,,: lfo�� v�� � ►
...............
...................................................
............
.JOB SITE INFORMATION (All Information Required)
Name: e&k-16t fh6,Lrt-�'b "/NAddress: '3,o �je( 4 t+ttrVot' -- .
Cross Street: t .
Phone No.: , -+his -~ M c
Bldg.Permit#: email: � Q.04f tr ... Act
--
Tax Map District: 1000 Section: k tl Block: Lot: (5rBRIEF I I N R , INCLUDE SQUARE TA ('Please Print Clearly).
Square Fo t 4.
Circle All That Apply:
Is job ready for inspection?: YES NO Rough In Final
Do you need a Temp Certificate?:, YES NO Issued On
Temp Information: (All information required)
Service Size 1:11 Ph E:13 Ph Size: A # Meters Old Meter#
New Service Fire Reconnect Flood Reconnect nservice Reconnect Flunderground Doverhead
# Underground Laterals 1 []2 H Frame Pole Work done on Service? Y N
Additional Information
i
PAYMENT DUE WITH APPLICATION
RON`
ZIRCONIUM,
7m
q�-
It
TT
J7,
#I'll
6111
i"J3
011
1 Z7V\`K
No r--
-wr-
'W"
A
Lk,
21
"IM
p�, 'C
N
iO'
'Aw ---A j"j,
O*ov
........
.........
AK
V,
—-—----------
T, Z
7,21
jt-
_4 -z--E
s
IIFE a
F PROPERTY
1 E TNEN L
TOM: 5OUTHOLD
%FFOLK CZVNIY, NY
SORVEYED Cq-20-20,22
5UFFOL<CAANTY TAX
1000-- 111—6 —1
SOT
HAP OF -K-M- ROS AGRE5m
lalwTD. FILEP JUKE 0,ITM FILE #6&q2
1 A V MARCZ iMN
� �
SHAM MARCFMEIN
CO181.161
DMM �� _ _
MAOA/A'� - - -
w
b `
3
43,
uj
� g
RA
It
L
Lij
IL
- lit
NOTE:5141
- a
FENCE
g
Y 022 5.F.or 0.46 ACRE
FLOOD ZONE X JOHN C. EM-ERS LAND SURVEYOR
ST MY .
RPAERREAD,N.Y.111 1—
_ RER—FNX-31 Q
Open layou with premium Adirondack
N4 7 seats and distinctive love seat *000
- 7, 7„ x 7, 7„ x 3, 1 ►►
-- Aft } � 2.31 m x 2.31 m x 0.94m
A� •;�: - Seats: 6
i
Therapy Pumps: 2
JetPaks: 6
Water Capacity:
i w w w w 1 456 ga 1 (1723 L)
Dry Weight:
900 Ibs (408 kg)
M Filled Weight:
--
- 5929 Ibs (2689 kg)
1 r
1 r
zz Q
i
Pulsator
Rainshower Reliever '
SpinalHealt