HomeMy WebLinkAbout51759-Z TOWN OF SOUTHOLD
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#: 51759 Date: 03/19/2025
Permission is hereby granted to:
Leor Shapiro
26 Kenworth Rd
Port Washington, NY 11050
To:
Legalize "as built" hot tub as applied for.
Premises Located at:
725 Jacobs Ln, Southold, NY 11971
SCTM#88.4-1.3
Pursuant to application dated 02/12/2025 and approved by the Building Inspector,.
To expire on 03/19/2027.
Contractors:
Required Inspections:
Fees:
As Built Pool/Hot Tub $600.00
CO Accessory $100.00
As Built Electric $250.00
Total $950.00
Building Inspector
W TOWN OF SO OLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P.O.Box 1179 Southold,NY 11971-0959
Telephone(631)765-1802 Fax(631) 765-9502 ltl ./Pr, otticlltar
Date Received
APPLICATION, F 0 R BUILDING PERMIT
For office Use Only
PERMIT NO. 5 1 5 Building lnspecr:_W `
FE
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant Is not the owner,an
Owners Authorisation form(Page 2)shall be completed.
Date:12.22.24
-OWNER(S)OFPROPERTY-.
Name:Kristen & Leor Shapiro scTM�1000-�88 -1�-13
Project Adclms:725 Jacobs Lane Southold
Phone#:516-238-6793 JEmail:kdsten.m.shapiro@gmail.com
Mailing Address:
AC " N:
Name:Joan Chambers
Mailing Address:PO BOX 49 Southold NY 11971
Phone#:631-294-4241 Emailloanchambers10@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name:Lou Schwartz
Mailing Address:7 Ridgewood St, Bay Shore, NY 11706
Phone#:(631) 410-6838 Email:tiderunnereng@gmail.com
CONTRACTOR INFORMATION:
Name:
as-built
Mailing Address:
Phone#: Email:
IDESCRIPTWN OF PROPOSED CONSTRLXTK)N
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
E1 Other as4)uiil hot tub on slab
Will the lot be re-graded? ❑Yes @No Will excess fill be removed from premises? ❑Yes @Na
1
R
PROPERTY INFORMA71ON
Existing use of property:residential Intended use of property:same
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
AC this property? I]Yes ONo IF YES,PROVIDE A COPY.
❑Check Box After Reading: Tm owwrww/ profasslonal k for ail and storm wowlsommorowwwbir
chapter zu er dwe Town Code. UM t5 NENMIE y MADE to the Department for dwa brwew wt are Bulift Permit to the Building Zone
Ordinanoe of V oT4waww d' sw�I1W County,New York and odor taws,ordinancesa ReBulaftu,for the construction of ,
additions, ar for r�or dwnoMJm as herein deaorlbed»The applicant arm to comply with all applicable laws,ordbwwces, code,
hou ft code and atd to tropectors on and ln "t)for ngce=ry lmpecftm false statanents made herein we
punishable as a Class A misdemeanor pwsuwt to Swtww sw 210.45 of the New yak Slate Penal law.
,
Appilicatim Submitted By(print name): ❑Authorized Agent ❑Owner
Signature of giant: Date:
0 CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.O I BU61 5050
Qualified in Suffolk County
COUNTY OF
Commission Expires April 14,264S
Joan Chambers being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the ~gent
(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
IV- day of 4 t 0vt AAZD °
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
Y`
f`L(Preslding at
� C OiLs �a
do hereby authorize Joan Chambers to apply on
my behalf to the Town cif Southpld Fll�ildinq� partment for approval as described herein.
s
Owner's Signature Date
rb tre')Ve
Print Owner i Name
2