HomeMy WebLinkAbout53292-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#: 53292 Date: 09/21/2026
Permission is hereby granted to:
Georgia Pantelides
27 Natalie Ct
Ronkonkoma, NY 11779
To:
construct an accessory in-ground swimming pool as applied for.
Premises Located at:
1335 Green Hill Ln, Greenport, NY 11944
SCTM# 33.-2-26
Pursuant to application dated 09/02/2026 and approved by the Building Inspector.
To expire on 09/20/2028.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total $400.00
��� Building Inspector � ��
a
" `° e 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 http ://ww^wwv sotitholdtownn
Date Received
APPLICATION FOR BUILDING PERMIT bwµ ( D
_ For Office Use Only
PERMIT NO. ff Building Inspector:
6�1) ...-
Applications and forms must be filled out in their entirety.Incomplete )qr", e t
applications will not be accepted. Where the Applicant is not the owner,anrs"t
Owner's Authorization form(Page 2)shall be completed.
Date: <' &
OWNER(S)OF PROPERTY:
Name: UVtS � SCTM# 1000- z ��
Project Address: � r„�
Phone#: Email:
Mailing Address: to )VV. .'
CONTACT PERSON:
Name: a
Mailing Address 0, � ,�,
Phone#: '
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: �� ` }Pod\ � �t-
Mailing Addvress 40" 8i�
Phone#: e;,. Email: , °',a- ,cam - r,lI't n e r,4A
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure DAddition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
(VOther� P r $ td�t3G
----------------
Will the lot be re-graded? Wyes El No Will excess fill be removed from premises? *es ONO
1
4 �
PROPERTY INFORMATION
Existing use of property: j 64ur� -)Zrt,;dA+1eu Intended se of operty:
6
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes'VINo 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
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 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): e > Authorized Agent ❑Owner 015 H
Signature of Applicant: Dater/z/z
E D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK)' No.01BU6185050
SS: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14, 2_0a_ ,�,
being duly sworn, deposes and says that(s)he is the applicant
(Nam
e e 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
day of "`�" � � 20 t 6z//-1
66
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
residing at cl-
i1 2 �
do hereby hereby authorize __� to apply on
,.
m b half to th " wn o outhold Building Department for approval as described herein.
Owner's Sign re Date
Print Owner's Name
2
LOT 132
Al
At
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C44AN `E' L94K FENCENi 1-1
le film—
_CED
p
'J4fool
4
STONE ORMWO
NO Poss.
3
S 69902110" W . 00 `
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"""fi r fir'.`k_; o" f ,"=-a s $._30