HomeMy WebLinkAbout52991-Z 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#: 52991 Date: 05/19/2026
Permission is hereby granted to:
Rebekah Schulz
300 Carleton Ave Apt 2201
Central Islip, NY 11722
To:
Construct an inground swimming pool at an existing single family dwelling as applied for.
*Maintain minimum 5'-0" setback as required.
**Addition toAwelling must be constructed,prior to the pool obtaining a CO
Premises Located at:
185 Riley Ave, Mattituck, NY 11952
SCTM# 141-4-29
Pursuant to application dated 04/17/2026 and approved by the Building Inspector,
To expire on 05/18/2028.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
$400.00
Buildin Inspector
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TOWN (J�' (�UTHOLD--BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
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Telephone (631) 765-1802 Fax (631) 765 9502 hf" � " ��T�� l�l of o °y l
Date Received
APPLICATION TOT BUILDING PERMIT"
i
For office Use Only
f
9 194
PERMIT No. Building Inspectoc '
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Applications and forms must be fulled out in them 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
OWNER(!)of PROPERTY:
Name:Rebekah Schulz SCTM# 1000-143-4-29
Project Address: 185 Riley Avenue, Mattituck
Phone#:631-871-5361 Email:rschulz79@hotmail.com
Mailing Address:1 85 Riley Avenue, Mattituck
CONTACT PERSON:
Name:Brooke Epperson
Mailing Address:PO Box 152, Mattituck, NY 11952
Phone#:531 603 9092 Email:bepperson@amparchitect.com
DESIGN PROFESSIONAL INFORMATION:
Name:Anthony Portillo
Mailing Address:po Box 152, Mattituck, N.Y. 11952
Phone#:531 603 9092 Email:aportillo@amparchitect.com
CONTRACTOR INFORMATION:
Name:
Mailing Address
Phone# Email
DESCRIPTION OF PROPOSED CONSTRUCTION
D New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
[■]other Inground Swimming Pool 75,000
Will the lot be re-graded? ❑Yes T No Will excess fill be removed from premises? Yes ❑No
..........
PROPERTY INFORMATION
Existing use of property:Single Family Residential Intended use of property:Single Family Residential
Zone or use district in which premises is situated.* Are there any covenants and restrictions with respect to
R.40 N on-Conforming . this property? FYes ',M No IF YES,, PROVIDE A COPY
19 Check BoxAfter Readings' The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPUCATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town 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 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.
■
@Authorized Agent Downer
Application Submitted By(print name).
2
Signature of Applicant: Date: s7
STATE OF NEW YORK)
s
S.
COUNTY OF
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signihg 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
A /
day of
20
eu
_Au(11L)::2+ Af
ry Public
DARCEE I-Ir-NANGER
NOiTARY PUBLIC,1,:;"J'ATE OF NEW YORK'
PROPERTY OWNER AUTHORIZATION Registration No. 01 A%U0019644
Qualified in SL foil
I
1F ' County
MINOR
'I' 2�_;q. Ljan/9,1,028
(Where the applicant is not the owner) commission Expires,
Q.A, residi ng at 185 Riley Avenue
Matt1tLIC�"C do hereby authorize I AM P Arch itec-ture to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
2,
Owner's Signature Date
� AL C "64-Al-o-
Print Owner's Name
2
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