HomeMy WebLinkAbout51760-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#: 51760 Date: 03/19/2025
Permission is hereby granted to:
Leor Shapiro
26 Kenworth Rd
Port Washington, NY 11050
To:
Legalize accessory"as built"outdoor shower as applied for.
Premises Located at:
725 Jacobs Ln, Southold, NY 11971
SCTM#88.-1-1.3
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 Accessory Structure $277.00
CO Accessory $100.00
Total $377.00
Building Inspector
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 httos*l/www.s;oiitholdto:wnnY-90—v
ry r'+fiMu@rm YY
Date Necelved
APPLICATION FOR BUILDING PERMIT
for office use Only
-71
PERMIT NO. Building inspWor: �!
Applications and forms must be filled out in their entirety.Incomplete
appiications will not be accepted. Where the Applicant Is not the owner,an
Owners Authorisation tam 2)shall be completed.
Date:12.22.24
II
OWNER(S)OF RTY-.:
Name:Kristen & Leor Shapiro +#1000-88.-1-1.3
Project Address:725 Jacobs Lane Southold
Phone#:516-238-6793 Email:kdsten.m.shapiro@gmail.com
Mailing Address:
CONTACrPERSON:
Name:Joan Chambers
MailingAddress:PO Box 49 Southold NY 11971
Phone#:631-294-4241 Emailloanchambers10@gmaii.com
DESIGN PROFMONAL I R "DON:
Nametou Schwartz
Mailing Address:7 Ridgewood St, Bay Shore, NY 11706
Phone#031) 410-6838 Email:tiderunnereng@gmail.com
CONTRACMR IN .
Name:as-built
Mailing Address:
Phone#: Email:
DESOMM OF PROPOSED CONMIJUM
❑New Stnuture ❑Addition ❑Alteration ❑ltepair ❑Demolition Estimated Cost of Project:
Mother outdo
Will the lot be re-graded? DYes INo will excess fill be removed from premises? ❑Yes @No
1
PROPERTY INFORMATION
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? OYes ONo IF YES,PROVIDE A COPY.
❑Check Box After Reading: the ownerlwavacw/doi wofusimw Is fesponeft foram drsksi and alm nowilatiesmapmvidedby
Chapter 2m of owTowr Cede.ANNuicai a"InERY MADE to the asi Department for the da NNIng to do wdli Zone
ordinsinta of*@ Toraiww of County,New York and other soplailgis Iawi Ordins aas or Replstlons,for the eonsbuetlm of b
houft addRJorts,a arior a as herein .the to oomph�s0 appgnbla blocs, code,
axle and and to ai sudimiallew,knpean I on Isaac and In b~j for naoesseq Inspeakni s.False statwnents made herein we
pwAftbleassoni mI 'in a-nor purvi to Seedon Z10A5 of the New Yak state Penal law.
Application SubmittedBY(P�nt name):
❑Authorized Agent ❑Owner
Sigroture of felt: Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
SS: No.01BU6185050
COUNTY OF f Qualified in Suffolk County
Commission Expires April 14,2
Joan Chambers being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he isthe Agent
(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
1-9-10ay of
Notary Public
AUTHORIZATIONPROPERTY OWNER
(Where the applicant is not the owner)
I l'Oresiding at t 0, L g\-k
____fio here Joan Chambers
by authorize to apply on
my behalf to the Tow of Southpld 89ildingj partment for approval as described herein.
C
n
Owner's Signature Date
rb
Print Owner"i Name
2