HomeMy WebLinkAbout53274-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#: 53274 Date: 09/15/2026
Permission is hereby granted to:
Francis Raia
28 Eagle Ln
Tappan, NY 10983
To:
Construct an inground swimming pool accessory to an existing single-family dwelling as applied for.
Pool and pool equipment must maintain setbacks of 20feet.
Premises Located at:
1815 Arrowhead Ln, Peconic, NY 11958
SCTM#98.-3-13.1
Pursuant to application dated 08/21/2026 and approved by the Building Inspector,.
To expire on 09/14/2028.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total $400.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
`s Town Hall Annex 54375 Main Road P. O. Box 1179 Southold NY 11971-0959
Telephone(631)765-1802 Fax (631) 765-95021a1 � w°
Date Received
APPLICATION FOR BUILDING PERMIT
E C E V E
For Office Use Only
a n
PERMIT NO. � Building Inspector:- G 2 9 %
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant Is not the owner,an Dwt:lwn Oe uthold
Owner's Authorization form(Page 2)shall be completed. Town ofouthid
Date: 6 -o
OWNER(S)OF PROPERTY:
Name: Ri=V, Qlaick
SCTM# 1000- qib- 03
Project Address: IbIS
Phone#: 0-1 Email:
Mailing Address: bv!� Vv cLL n
CONTACT PERSON:
Name: n(Xy
Mailing Address: S UtAn, no CL hC)Y- \-C 1 t Q4 9
Phone#: S _ Q Email: "
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: 2ab2u,
S �S
MailingAddress2 aq + aQo IIg4
Phone#: (03 I - --1•u c-6 1 Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
[]New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cos of Project:
Efpther Y\J A\)( t
Will the lot be re-graded? ❑Yes o Will excess fill be removed from premises?'Iees ❑No
1
PROPERTY INFORMATION
Existing use of property: Intended use of property: c
Zone or use district in which premise is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes* IF YES, PROVIDE A COPY.
tDeck Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water Issues as provided by
er 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): &Ina Wlel-C.U'lb AAuthorized Agent Downer
'�)ai I
Signature of Applicant: gate: '
STATE OF NEW YORK)
SS:
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
(Contract r, Agent
to m
Corporate Officer,etc.)
of said owner or owners, and is duly authoriz ed 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
day of ALAou4 � C1401-011
—jeR 114,
Olotary Public
r A��ErY L. O Y R
a C TAaTY PUBLIC,STATE OF NEW YORK
PROPERTY OWNER AUTHORIZATION "0-01 DW63 6900
QUALIriko IN SUFFOLK COUNTY
(Where the applicant is not the owner) COMNa ssI EXP' jFjES JUKE 30,2ao
I, 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
- Building pegarIMet �Ie Itrn
AUTLJORIZATI
(Where the Applicant is not the Owner)
residing at
�
�.�
(Print property owner's name) Mailing Address)
-Poo If
"do hereby authorize
(Agent)
to apply on my behalf to the
Southold Building Department.
" azure (Date)
.`
Owners 1' atu
1 1;
Albert J. Krupski, Jr. 5'7��0)RW
I��l[ A\�C]EIE�
SUPERVISOR
MA\,NA\,(Gt]EM1ENT
SOUTHOLD TOWN HALL-P.O.Box 1179 Town Of Southold
53095 Main Road-SOUTHOLD,NEW YORK 119ni a •y
CHAPTER 236 - STORMWATER MANAGEMENT REFERRAL FORM
(APPLICANT INFORMATION TO BE COMPLETED BY THE APPLICANT
ONLY FOR PROPERTIES ONE ACRE IN AREA OR LARGER-)
APPLICANT: (Property Owner, Design Professional, Agent, Contractor, Other)
NAME: �it � Date:
Lr=- � � � Contact Information- _ � E � �
fit
Prortv Aress 1 Location of Construction Site:
L
D�strtct
- - ` & �
Section Block Lot
TO BE COMPLETED BY SOUTHOLD TOWN ENGINEERING DEPARTMENT
Area of Disturbance is less than 1 Acre No S-RD E 5 Permit is Required'
- Project does Not Discharge to Waters of the State. No S.P.D.E.S.Permit is Required I
- Area of Disturbance is Greater than I -acre&Stffmn-water P n ft Dischanzei Di= e _'
to Waters of the State of New York TFtE -PPL IC,z'NT XIUS C)BT=Xt\a s P D E, Pent=it
- Area of Disturbance is Greater than I Acre&Storm-water Runoff Flows Through Southold
Town's M54 Systems to Waters of the State of New York. THE APPLICANT,MUST OBTAIN
a S P E 5 Permit thr- E"the �fSn T-1 Enk- r::
Prior 1 v of e a& d- }Pe ,. —
Reviewed B� --,� � ' Dave
FORM ' SMCP-TOS December 2024
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ROUC�M-fRAMtNGBPLUMBING
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