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HomeMy WebLinkAbout53015-Z TOWN OF SOUTHOLD BUILDING DEPARTMENT ` SOUTHOLD, NY co 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#: 53015 Date: 05/22/2026 Permission is hereby granted to: Laura Willumstad 502 Bailey Ave Greenport, NY 11944 To: install an accessory above-ground swimming pool as applied for. Pool equipment must be located in the rear yard with minimum 5'setbacks to lot lines. Premises Located at: 965 Champlin PI, Greenport, NY 11944 SCTM#34:414 Pursuant to application dated 05/13/2026 and approved by the Building Inspector. To expire on 05/21/2028. Contractors: Required Inspections: Fees: SWIMMING POOLS-ABOVE-GROUND WITH REQUIRED FENCING $300.00 CO Swimming Pool $100.00 Total $400.00 Building Inspector dry�"`� {»,.,. 401" " � TOWN OF SOU'Y HOLD--BUILDING DEPARTMENT Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold, NY 11971-0959 Telephone(631) 765-1802 Fax (631) 765-9502 mrov Date Received APPLICATION FOR BUILDING PERMIT 0 ` oc m«o.'wa �mMm'° emu uOU kv" For Office Use Only 01 PERMIT NO. Building Inspector,,�1 Applications andforms must he 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: 457 OWNER(s)61F PRbPER'TY'. Name: 1.000#SCTM - .... -- � • ` , ' Au ie Project Address: Phone#: d,2 Email ................. 0 u' Mailing Address.y eo," A' " 'Ve' 11?VV CONTACT PERSON: 4ic— NameA o Mailing Address: Phone#: Email: DESIGN PROFESSIONAL INFORMATION: Name- Mailing Address: Phone#: Email: CONTRACTOR INFORMATION: Name: LC) E7 Is r Mailing Address: C-00 Phone#: 9 'O �3 Sow Email.; DESCRIPTION OF PROPOSED CONSTRUCTION ❑New Structure ❑Addition F-IAlteration ❑Repair ❑Demolition ► Estimated Cost of Project: ❑other �' o 'L_ $ Will the lot be re-graded? C�Yes ❑No Will excess fill be removed from remises? ❑Yes ❑No g p 1 PROPERTY INFORMATION 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 Ll#property? ❑Yes F-71No IF YES,, PROVIDE A COPY. 0 Check Box After Reading: The owner/contractor/design 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 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. Application Submitted By(print,name): L Lt L1 0 T-A+A ElAuthorized Agent weer 0 e r Date: Signature of Applicant: I - /"' oe>t 011 CONNIE D.BUNCH STATE OF NEW YORK) Notary Public,State of New York SS: No.OIBU6185050 Qualif led In Suffolk County Commission Expires April 14,2W41- COUNTY OF 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 per-form 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 ay of 20 Notary Public PROPERTY OWNER AUTHORIZATION (Where the applicant is not the owner) 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 g - p TUT H 1 L L TH Yu O E �""� "� . s _ m TOWN; O�- SO UT E. 2- WOOD b i a - v t 1 rT©fzy -HOF �� t - F 0- :MONUMENT l{ ,.t}3� , - _ �F t V E CIA�FYLIN TL . r f ATLANTIC eg GU . RMI IRST �`- - _ - � AN TI 1_6�-�tOf ,Y. A r,dz- � s - - -2 _£. � _ _ a A*Pand act an(#6aQ to tha 19�0 _ �� tjL SOF# , =i)(MAP I —0 3 4~ i+!4LANO __ - Sai^ts.{1_. anti cans gabs F LIC - s a s L04 Y rt_ a F >