HomeMy WebLinkAbout52470-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#: 52470 Date: 11/18/2025
Permission is hereby granted to:
Lauren B Gordon
825 Kimberly Ln
Southold, NY 11971
To:
construct interior alterations to an existing single-family dwelling as applied for.
Premises Located at:
825 Kimberly Ln, Southold, NY 11971
SCTM# 70.-13-20.5
Pursuant to application dated 10/03/2025 and approved by the Building Inspector.
To expire on 11/18/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $445.75
CO-RESIDENTIAL $100.00
Total $545.75
� ��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 ht�tps://www.soutlioldtoivnny.g_ov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. !2Building Inspector:
Applications and forms must be filled out in their entirety.Incomplete i4 T." f I"
applications will not be accepted. Where the Applicant is not the owner,any r
Owners Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: Laurie Gordon SCTM# 1000- 70-13-20.5
Project Address: 825 Kimberly Lane, Southold NY 11971
Phone#: 917-282-8585 Email: Igmandelbaum@aol.com
Mailing Address:
CONTACT PERSON:
Name: Christopher Powers
Mailing Address: PO Box 400, South Jamesport NY 11970
Phone#: 801-558-3501 Email: Christopher@powershancockdesign.com
DESIGN PROFESSIONAL INFORMATION:
Name: Christopher Powers
Mailing Address: PO Box 400, South Jamesport NY 11970
Phone#: 801-558-3501 JE�ikhristopher@powershancockdesign.com
CONTRACTOR INFORMATION:
Name: North Fork Woodworks, Inc.
Mailing Address: PO Box 1407, Southold NY 11971
Phone#: 631-298-7900 Email: rachel@nfwoodworks.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ®Alteration ❑Repair ❑Demolition Estimated Cost of Project:
[]Other New windows and partial interior renovation $ 500,000
Will the lot be re-graded? ❑Yes ®No Will excess fill be removed from premises? ❑Yes 50 No
1
PROPERTY INFORMATION
Existing use of property:Residential Intended use of property:Residential
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 this property? ❑Yes M'No IF YES,PROVIDE A COPY.
IN Check box After Reading,, The r/con l is provkled by
OmPter 2M of the Town Code. APPLICATION IS HEREBY MADE to the Bulidhq Deperbrient for the bsumos of a Bu&w g Permit pwwant to the Bulldlng Zone
or&wroe of the Town of Soutiwks.Surfolk County,New York and other Laws,Ordinances or Regulations.forthe construction of buG*W,
addleions,a terations or far rertwsal or dernolrtion as herein described.The applicant agrees to comply with all gVilcable laws,wtilromes,bulldrng code,
hordng code aed reguWtlons and to admit authorized 6apectom on premises and in bufldtng(s)for neceLwy inpectior s.False statements made herein are
W*Awble as a Gass A mbderneerpor pursumm to section 21OA5 of the New York Stases penal tame.
Application Submitted By(print Christopher Powers PlAuthoraed Agent ❑Owner
Signature of Applicant: Date:
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified in Suffolk County
COUNTY OF ) Commission Expires April 14,2nag
Christopher Powers
being duty sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Agent
(Contractor,Agent,Corporate Officer,etc.)
of said owner or owners,and is duty 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 <f�)C4--Q .20
Notary Public
(Where the applicant is not the owner)
1, �rCC70400 residing at 1 m r La h� o K �Io Id
do hereby authorize G h V'(S-ke V wCvs #o apply on
my ehalf to the T wn or uthold Building Department for approval as described herein.
Owner* na Lure Date
&re yx &0'
�f 40
Print Owner's Name