HomeMy WebLinkAbout53220-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#: 53220 Date: 08/24/2026
Permission is hereby granted to:
Gary Noskewicz
5 Linden Ct
Hicksville, NY 118013106
To:
construct an accessory in-ground swimming pool as applied for. The swimming pool and pool
equipment must be located in the rear yard and must maintain a minimum side&rearyard setback of
10 feet.
Premises Located at:
640 N Bayview Road Ext, Southold, NY 11971
SCTM#78.-9-42
Pursuant to application dated 08/10/2026 and approved by the Building Inspector.
To expire on 08/23/2028.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
W,
Total $400.00
Building Inspector ���
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CIO
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax(631) 765-9502 tt s:H r�vw,sotitliol(itownn . Gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use only
PERMIT NO. Building InspectorM
Applications and forms must be filled out in their entirety.Incomplete o Itoeot
applications will not be accepted. Where the Applicant is not the owner,an epod
Owner's Authorization form(Page Z)shall be completed. �o
Date:
OWNERS)OF PROPERTY:
Name° SCTM# i10 - t
Project Address: L
Phone#: Email:
Pe
Mailing Address:
CONTACT PERSON:
Name:awlku 0�
Mailing Address:
Phone#: / t Email:
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: 7W /E-- I Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address
�f
Phone#: (021—
Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
ear Structure dzitizeTtionORTair 0 1° V DEstimated Cost of Project:
Other
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises? ❑Yes 4NO
1
PROPERTY INFORMATION
Existing use of property: dA(l I
Intended use of property:
Zone or use district in which premises is situated: Are there any covenants cd restr'ictions with respect to
this property's ❑Yes IF YES,PROVIDE A COPY.
ef
heck Box After Reading: Tha a nter/cant /'deskn prWesstonal is nmpmlble for all drahu"and stop. water lsstaes as PMVWW by
chapter in of the Town code.APPucATwN is HEREBY m=E to flea Bs nft Department for the twoonoa ate Bu0cft Permit purnwd tc the 9WWhV Zama
ord h i , of the Tows of Soutl>rrlsl,suffalk,County,Naw York must other applicable laws,ordbnsnm or Brauladtom ft the consumdonotbuildh1s,
addhlorm altmattons or for ramoral or drsmall lon as heraks davxtbed.The appticasrt epees to comply with all appilcable taws,ordbumm,buBft code,
housft code and regulatons and to admit authorized Inspeftrs on pram lm and In bulldinl*)for necessary Inspectlarm Fatse statements mode heraln are
punhhable as a Class A snisdemearw pur ua t to secdon Z10.4b of the New York State Penal law.
Application Submitted By(print name): ❑Authorized Agent ❑Owner
Signature of Applicant: Date:
STATE OF NEW YORK)
w
COUNTYOF (-)
anWOW being duly sworn,deposes and says that(s)he is the applicant
J& 0
(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.
No
re m his �n
20 �1/
Notary Pub c
PROPERTY OWNER AUTHORIZA IO j4k
NC1
ARPUBLIC, LE OF fdEV+1 'OR
(Where the applicant is not the own r Re01 FR6112 94
Qt'f'olk Countyes July 06,202R
residing at /0-Mdo hereb Y authorize Mo apply on
my beha the To n of S old Bu" 'ing Department for approval as described her in.
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Owner's Signer ure Date
Ohm, A0 V-0 Wv--11
Print Owner's Name
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