HomeMy WebLinkAbout53091-Z TOWN OF SOUTHOLD
� ot BUILDING DEPARTMENT
SOUTHOLD, NY
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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#: 53091 Date: 06/25/2026
Permission is hereby granted to:
Jane McSweeney
33 Ridgebury Rd
Brewster, NY 10509
To:
construct a new pool fence enclosure as applied for.
Premises Located at:
1750 Water Terrace, Southold, NY 11971
SCTM#8$.-6-13.14
Pursuant to application dated 06/09/2026 and approved by the Building Inspector.
To expire on 06/24/2028.
Contractors:
Required Inspections:
Fees:
Pool Fence $125.00
CO Swimming Pool $100.00
Tota I 225.00
Building Inspector
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X TOWN OF OUTHOLD--BUILDINGDEPARTMENT
Southold NY 11971-0959
�1�"P AV� Town Hall Annex 543751VIa�n:�.Oad.P. 0. Box 1179 a ,
Sl 4l
Tele hone 1 765-102 Fax ((/ 31 yji 75-9502 .W � w SOl , . 0
Gate Received
APPLICATION FOR BUILDING PERMIT
. rra
For Office Use Only
OilPERMIT NO. Building Inspector:
...........
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Applications and forms must be filled out in their entirety. lnco mpl:ete
applications will hot,,be accepted. Where the Applicant Is not the owner,an � r ���,, 0 '
Owner's Authorization form(Page 2)shaill be completed. ,�F� �� ��.��4
Date: 1,4110 2,ae '6
OWNER,, R K 77
Name#' SCTM 1000- llqw
...............
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ct Address:
Phone#: -- 0-13, f f I
Email '
...........
Mailing Address: 6.1
s
CONTA,CT PERSON.
Name J .,7 e ,s
Mailing Address:
�� �rr�al Phone#, / ' ' Jer-
of 0�
FN,ame*,,
MaJ it Addr ss:
Phone M. Email:
CONTRACTOR INFORMATION:
Name: -- ,7 ce,
aili Address:
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Phone#:, E m ai1,
I F PROPOSED,CONST'RUCTION NJ
0 0 ON WON
❑New Structure C]Addition FlAlteration 17-71 Repair ❑Demolition Estj miated Cost of ro ect::
then e
........
Will the lot be re-graded? C]Ye ,00 Will excess fill be removed from premises? C]Yes
i
1
PROPERTY INFORMATION
Existing -
sting use of property: Intended use of property:
—----------------------I. 11
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? 7Yes 7No IF YES, PROVIDE A COPY.
Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided,by
Chlapter 236,,of the"Town Cod,,j6,,,'APPLIcATIONAS'HEREBY MADE to''the'SyRdlng Departhone,nt for,the,lissuance of a Building Permit pursuant to,the Ouildingl2one
Or4inAnte bf 6"e,Tawn of'S66tho"Id'o Svffolk, li,cable.'Uwt ordina,nce�,b,,Re ula�ti,ons�'fur"'tale l�tonstr"Oction�'ofboitd,1 ',
additions af aeration s-or,for rernoval or,dern,olfflom,as,herein,'desCribed'."The a licant agreesl ppo',,com with al[ao'lkablt laws;ordInanta�j b i di g cd e,
ply, P r p
an Sp essary,fj$ verein,are
4e ins e rem ses,,ah ng, r, ,c
ho�sjn,g,code adipft'a'uthio'r"i-dl '-dorS,,,,64i3O` i &Inbulldl o''66 " I pLictions,Falsestatements made'h
purilshable as;a Class misdernea nor,p"ursuant,to Section S'W'111te,Pena I La W4
Application Submitted By(print name):- DAuthorized Agent Downer
Signature of Apan pfic "'A Date.:
an
CONNIE j3UNCH
ublict "t�tj
STATE OF NEWYOR Notary Public ,late of New York
SS: N .0 1 BU61 85,051,0'
Qualified In Suffolk County,
COUNTY OF 0om,mls,slon, ExPires,April, 14,2� ,
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
1b 4�lay of, 20 01
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