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TOWN OF SOUTHOLD
tF
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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#: 49862 Date: 10/10/2023
Permission is hereby granted to:
Zuckerman J Livin Trt
1510 E Gillette Dr
East Marion, NY 11939
To: construct accessory outdoor shower as applied for.
At premises located at:
1510 E Gillette Dr, East Marion
SCTM #473889
Sec/Block/Lot# 38.-3-25
Pursuant to application dated 9/20/2023 and approved by the Building Inspector.
To expire on 4/10/2025.
Fees:
ACCESSORY $100.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $150.00
Building Inspector
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 https://www.southoldtownU.gov
Date Received
APPLICATION FOR BUILDING PERMIT
A,, 0
For Office Use Only
PERMIT NO. +� Building Inspector. Gm P
2 0 2023
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an Building Department
Owner's Authorization form(Page'Z)shall be completed. Town of Southo6d
Date: c5'E� . ) q '7,0-2,7
OWNER(S)OF PROPERTY:
Name: \30E U r-KZV_MkN SCTM#1000- ?)g -0a -S5-
Project
SProject Address: Ga('St-0 E . GlLt,E-CTE ,XRIIIS EA�-ST "(ZlC3^J
Phone#: ( — -Il� '"�� _�(� Email: p��Z L91 03 rriQt . e�rr1
Mailing Address: S(0 E , 6(('L-S-rM TJ12.1 JJF- 1EPsST— IIAA-IanJ
CONTACT PERSON:
Name: J OkN e f-t*(yol5S
Mailing Address: po S pX 4 LI
Phone#: 10 3f — 2 AA '�42�'/ Email: '�Q✓�C�l0.rr�IQ.Qr�1' m e (.CQ
DESIGN PROFESSIONAL INFORMATION:
Name: 3LJ C 4°iW-rii.'r „
Mailing Address: 71 EZL9Cs-1lff W004 Sl--
Phone
-Phone#: Emall:
631— 4�u-- 6838 i c.�-e�unn�revt � w�a�� .e�r►-�
'CONTRACTOR INFORMATION,
Name:
Mailing Address
Phone#: Emailt
DESCRIPTION OF PROPOSED CONSTRUCTION
' New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other U'C 00 $
Will the lot be re-graded? Dyes Lfl0 Will excess fill be removed from premises? ❑Yes',kgNo
1
PR0,14ERT1(`INFORMATION
U
Existing use of property: _ 4,>ti Kest C>Ey\jcIntended use of property; A mfr
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
tZ_4.0 this property? ❑Yes ❑No IF YES, PROVIDE A COPY.
❑ Check BOX After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as prc4l by j
Chaster 23 the fowq Code AI*2LICA#IOf�L�)1EREBY NIAOE to the Building Department for the Issuance of a Building Permit pursuant to the Building Zone'
ordinancer, oFfhe"f iwn of s'`cN(tho d Sutlfolk,County New York and other applicable Laws,ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demoUtion as herein described fie applicant agrees to comply with ah applicable laws ordinances,building code,
housin t4de and regulations and to"admit autffbrfted Inspectors on premises and in buildings)for necessary inspections.False stai6ments made herein are
punishable as a Gass A'misdemeenor,pursuarft to 5ection,210,45 of the ivew Yolk State Penal,Law,
Application
Submitted By(print name): Authorized Agentent ❑Owner
Signature of Applicant: Date: 9 -,Z Q—23
STATE OF NEW YORK)
SS:
COUNTY OFfj ,
a )
�fs 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,�Agentorporate Officer, etc.)
of said owner or owners, and is duly authorized to por 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
2 day of 20 Al
Totary Public
TRACED L. DWYE-:R
PROPERTY OWNER AUTHORIZATION NosA
RY PUBLIC,L
IC,5T
�FEOF
N U.01 D6306ryry01,
�Sf
(Where the applicant is not the owner) 0WALIFIED IN SUFFOLK COUNTY
COMWSSION EXPRES JUNE
I, AD E 7—U CV-- A- " residing at S� b &4 LLZr lu
C�T MAnkyA/ do hereby authorize JO AC,v Cpm l0ZS to apply on
my behalf to the Town of Southold Building Department for approval as described hereln.
9 . 2f •Z3
wner's 'ignature Date
6E Zt,etcEarAAvJ
Print Owner's Name
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REMOVE EXIST. STAIRS. - FESSID
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SHOWER
EXISTING STOOP PLAN & STOOP
ALTERATION $_22.23
1 /4„ = 1 ,_01, 1 /4" = 1,_0„
JOAN CHAMBERS
(631)294-4214