HomeMy WebLinkAbout52573-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#: 52573 Date: 12/23/2025
Permission is hereby granted to:
liana Friedman
PO BOX 1059
Southold, NY 11971
To:
Construct an inground swimming pool accessory to a single-family dwelling as applied for. Pool and
pool equipment require a five-foot setback.
Premises Located at:
1085 Gin Ln, Southold, NY 11971
SCTM#88.-4-9
Pursuant to application dated 10/31/202S and approved by the Building Inspector.
To expire on 12/23/2027.
Contractors:
Required Inspections:
Fees:
SWIMMING POOLS-IN-GROUND WITH FENCE ENCLOSURE $300.00
CO Swimming Pool $100.00
Total S400.00
Building Inspector
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7 -7 TOWN OF SOUTHOLD-BUILDIl4G D
Town Hall Annex 54375 Main Read P. O. Box 1179 Sout}�dd,NY%J.,1971-0959
Telephone(631) 765-1802 Fax(631) 765-95021tt
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DdL!ft"ened
APPLICATION FOR BUILDING PER WIT-
For For off eUuovi
PERMIT NO,51-5-0.�
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Date:
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Name:
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Project Address f
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Phone#m ... . Email
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Mailing Address:
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Name:
Mailing Address
Phone# 3 3 Email
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Mailing Address:
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Phone III:
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Name:
Mailing Address:
Phone#:
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O h S r t re EAddition OAtterapon Oft 1'r ❑D&hblf in SOftated Cost of Project:
/ C10,000
„" Gorur r
Will the>Jt be re-graded? ❑Yes l�IVo No
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Existing use
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intended,use of'pro
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Zone or use district in
hi h pr rpis s is situated Are ther�,a,ny covenants and restrictions with respect peel to
this property? 71Yes -No IF YES PROVIDE A copy_
Application Submitted By(print rrarrie);
� utorlze nt ®Owner
Signature of Applicant:
,*
`FATE OF NEW YtaRK
SS:
COUNTY OF
(Name of endividuai s r.�n contract) above namede...0 .being duly sworn, deposes and says that(s)he is the applicant
(S)he is the
(CoAgent,
of said o�arner or owners, grid is ddulyauthorized to perform or have performed the said work and to make acid file this
application;that all statements contained in this application are true to the best of his/her kno led e and belief;and
that the work will be performed in the manner set Pooh in the application file therewith
Sworn before me this
day of
Notary Public
(Where t ( t , a . � '
residing
do hereby authorize ,
to apply or,
emn y dfi� �d �
of So Department ir for
approval as described herein,.
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/r iner°s Name
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