HomeMy WebLinkAbout53112-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#: 53112 Date: 07/07/2026
Permission is hereby granted to:
Kenneth McGorry
3 Orchard Farm Rd
Port Washington, NY 11050
To-,
Construct in ground swimming pool at existing single family dwelling as applied for.
Maintain minimum 10 foot setback to side and rear property lines as required.
Premises Located at:
1995 Ruth Rd, Mattituck, NY 11952
SCTM# 106.-7-7
Pursuant to application dated 06/24/2026 and approved by the Building Inspector.
To expire on 07/06/2028.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
17 al 400.00
Building Inspector
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TOWN OF SOUTHOLD--BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
ne (631) 765-1802 F`ax (631) 765-9502 Y s� ' � - ,. i,,tl ldtownn °.,.N p�Telepho
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Date Received
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PPL CAT CAN NCR BUILDINGPNRMITAu.
For Office Use Only JUN 4, 1 6 a
NO. Building
PERMIT �Inspector:
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Applications and forms must be filled out in their entirety. Incomplete of of th o)' I,
applications will not be accepted. Where the Applicant is not the owner,are
Owner's Authorization form(Page"')shall be completed.
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OWN ER(S)of PROPERTY:
Name t" . SCTM # 1000- --
Praject Address:
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hone#: Email:
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Mailing Address:
CONTACT PERSON:
Narne* Ole
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Mailing Address:
Phone#: Email: let,
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DESIGN PROFESSIONALINFORMATION:
Name;
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Mailing Address
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Email
Phone#
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CONTRACTOR INFORMATION:
Name:
Mailingress�
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Phone#: Email:
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DESCRIPTION of PROPOSED CONSTRUCTION
New Structure ❑Addition r7Alteration ❑Repair ❑Demolition Este ed Co1 t of Project:
Other
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Will the lot be re-graded? ❑Yes Will excess fill be removed from premises? Yes ❑No
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...............
...............
PROPERTY INFORMATION
Existing use of property: Intended use of property:
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Are there any covenants, d restrictions with respect to on , or use di ,trict in which premises is situated:
this property? FlYes o, IF YES, P ROVI D E A COPY,
ec k Box After Reading: The owner/contractor/design professional is responsible for all drainage a j' store water issues as provided by
hapter,236 of the Town Code. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a8uild n 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): ElAuthor"a A yed ent ner oi
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Signature of Applicant, Date: Ur
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STATE OF NEW YORK)
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01JAIJIFIED,IN
S, U F FO LK COUNTY'P CO .1, ZVI U 'OF .c 01 IMM,
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b" U and says that (s)he is the applicant
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(Name of individual signing contract) above named, OF N
(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
ry
day of
Noiary 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