HomeMy WebLinkAbout53102-Z �o��a�sa�rryold 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#: 53102 Date: 06/30/2026
Permission is hereby granted to:
George Dapontes
c/o Maria Dougherty
East Elmhurst, NY 11370
To:
construct an accessory in-ground swimming pool as applied for.
Premises Located at:
1050 7asker Ln, Greenport, NY 11944
SCTM#33.4-36
Pursuant to application dated 06/15/2026 and approved by the Building Inspector.
To expire an 06/29/2028.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Poo! $100.00
Total $400.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main.Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone (631)765--1802 Fax (631) 765-9502 tat . � .soutl old ow�n,n.
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Date Received
APPLICATION FOR BUILDING PERMIT
E E Is E
For Office Use only
JUN 1 5 2026
PERMIT NO. Building Insecoi°
Applications and forms must be filled out in their entirety.Incomplete Building Department
applications will not be accepted. Where the Applicant is not the owner,an
Town of Southold
Owner's Authorization form(Page 2)shall be completed.
Date. f
OWNER(S)OF PROPERTY:
Name: SCTM#1000- D 0' b,,30,060
Project Address: -
Phone#: 51(op Email: .ORL00w6a i 0, 6PO4
Mailing Address: "�. �" 11�14
4�,
CONTACT PERSON:
Name: AJ 400
Mailing Address: . C� 60v z3Di jsL4 e 04 0 7-1�l
Phone#: - Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: S e V_ ,S+Q-A Poo\$) 'r)'C.-,�
µµ
!Mailing Address; d Do G de.,� .- nd,a.) $ "7 y
Phone#: Email: C r , ,,4 �s a +--r--�,S+ PI)
DESCRIPTION OF PROPOSED CONSTRUCTION
O New Structure ❑Addition ClAlteration ❑Repair ❑Demolition Estimated Cost of Project:
❑other $
Will the lot be re-graded? flYes ❑No Will excess fill be removed from premises? DYes ❑No
PROPERTY INFORMATION
Existing use of property: d intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes C7 No IF YES, PROVIDE A COPY.
D Check Box After Redding: 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 coda,
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 B (print name): /// ❑Authorized Agent flOw rer
Signature of Applicant: Date:
STATE OF NEW YORK)
SS:
COUNTY OF144o "
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the #7 Al
r
(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
JA day of 2064V,
Notary Public MIGDALIA A ROQUE
]NOTARY PUBLIC,STATE OF NEW YORK
QUALIFIED IN SUFFOLK COUNTY
PROPERTY OWNER AUTHORIZATION NO
. R46173781
COMMISSION EXPIRES 1112
(Where the applicant is not the owner)
!, residing at
do hereby authorize to apply on
m
my behalf to the Town of Southold Building department for approval as described herein.
Owner's Signature Date
Print owner's Name
2
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