HomeMy WebLinkAbout52967-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
2
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#: 52967 Date: 05/12/2026
Permission is hereby granted to:
Jeremy Littler
15 Henderson Ave
Port Washington, NY 11050
To:
construct an accessory in-ground swimming pool as applied for. All gates must saving outward.
Premises Located at:
2120 Brigantine Dr, 'Southold, NY 11971
SCTM# 79.-4-22
Pursuant to application dated 04/27/2026 and approved by the Building inspector.
To expire on 05/11/2028.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO S itl o ng Pool $100.00
w.
Total ' 400.00
' ing Inspector
, s TON"OF SOUTHOLD--BUILDING DEPARTMENT
Town.Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 1 1 97 1-0959
Telephone (631) 7 1802 Fax (631)765 95
Date Received
APPLICATIONFOR BUILDING PERMIT
j For Office Use Only w
m
m ro
PERMIT NO., Building ecton
Applications and forms must be filled out in their entirety.Incomplete A P 1�,
applications will not be accepted. Where the Applicant Is not the owner,an
I wnees Authorization form(Page 2)shall be completed.
Date:04.27.26
OWNER(S)OF PROPERTY:
Name:Celine Mo �& Adrian Adamkovic SCTM 1 ' -79 04-22
Project Address:2120 Brigantine Drive
Phone#:631.513.6589 Email:ZENicholson.ArchC&gmail.com
Mailing Address:
CONTACT PERSON:
Name: RA
Zacke E. Nicholson,
Mailing Address:PO Box 88 - Cutchogue, NY 11935
Phone#:631.513.8589 Email:ZENicholson.Arch@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Zackery E. Nicholson, RA
Mar
• r
lin Address:
g PCB Sox 38 - Cutchogue, NY 11935
Phone#:531.513.859 Email:ZENicholson.ArchCgma.il.ccm
CONTRACT
OR INFORMATION:
Name:TBD
Mailing I i ng Address:
a d
Phone#: Email:
000
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ClAddition DAlteration M Repair D Demolition Estimated Cast of Project:
Bother Pooh
Will the lot be re-graded? RYes 0 No Will excess fill be removed from premises? C]Yes MNo
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PROPER7Y INFORMATION
FExisting use of Property:Single Family Dwelling Intended use of property:Single Family Dwelling
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
'� R 4O this property? DYes R No IF YES., PROVIDE A COPY.
Cl—,CItileic l(,-13�ox,Afteir�Re,aid','I'lillg�'. 7he owner/contractor/design proliesslonal Is responsible for all drainage and storm water Issues as pmWftd by
Chapter 236 ofthe town We. APPILICAlnON IS WROY MADE to the Building Department for dw bsuance of a Bu#dMg Permit pursuw*to the Building Zone
Ordinance of the Town of Southold,Suffok County,New York and other applicable Laws,Ordinances or Regulations,for the consbvctlon of bulwhwp
additions,alterations or for removal or demolition as hereln desedbedL The applicant agrees to comply with all applicable laws,ordinances,bundlng code,,
housing code and regulations and to admit authorized Inspectors on promises and In building(s)for necessary Inspections.False statenrAb made herein are
punishable as a Class A misdemeanor pursuant to Section 210AS of the Now York State Pend tm,
I
Application Submitted By(print name C y Es Nicholson, RA @Authorized Agent DOwner
Signature of Applicant: Date: 04.27.26
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.OIBU6185050
Ouallfled In Suffolk County
COUNTY OF Commission Expires April 14,2L)e
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 ay of 20 C
Notary Public
PROPERTY OWNER AUTHORIZATION
wm�
(Where the applicant is not the owner)
0 7'wl� Id
I'? tiLl residing at, J/30 1444 P HiijW00
41
l
do hereby authorize, ZC16kc4�V 0�0-' to,apply on
my behalf he,Town of Southold Building Department for approval as described herein.
J 6'
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6"""e el Owner's Signature Date
Print Owner's Name
2
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