HomeMy WebLinkAbout53259-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#: 53259 pate: 09/10/2026
Permission is hereby granted to:
Leor Shapiro
26 Kenworth Rd
Port Washington, NY 11050
To:
install an accessory pickleball/sports court as applied for. The court must maintain minimum side and
rear yard setbacks of 15 feet.
Premises Located at:
725 Jacobs Ln, Southold, NY 11971
SCTM# 88.1-1.3
Pursuant to application dated 08/20/2026 and approved by the Building Inspector.
To expire on 09/09/2028.
Contractors:
Required Inspections:
Fees:
CO Accessory $100.00
Accessory-New Structure $125.00
Total $225.00
�— Building Inspector
� TOWN OF SOUTHOLD—BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone (631) 765-1802 Fax (631) 765-9502 tts, :� a/�w �� l �s& w� x�fl�. ��wkµ
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector. A U G 0
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an Building Department
Owner's Authorization form(Page 2)shall be completed. Town of Southold
Date:4/16/2025
OWNER(S)OF PROPERTY;
Name:Leor Shapiro SCTM#1000-8$-01-1.3
Project Address:725 Jacobs Lane, Southold, NY 11971
Phone#:516 946 6236 1 Email:leor.shapiro16@gmail.com
Mailing Address:26 Kenworth Road, Port Washington, NY 11050
CONTACT PERSON:
Name:game as above
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name:White Diamond Construction
Mailing Address:975 W Jericho Turnpike, Suite 2, Smithtown NY 11787
Phone#:631 944 3434 Email:whitediamondconstructions@gmail.com
CONTRACTOR INFORMATION:
Name:White Diamond Construction
Mailing Address:975 W Jericho Turnpike, Suite 2, Smithtown NY 11787
Phone#:631 944 3434 Email:whitediamondconstructions@gmail.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration DRepair ❑Demolition Estimated Cost of Project:
51 Other Pickleball/sport court $40,000
Will the lot be re-graded? *Yes El No Will excess fill be removed from premises? *Yes ❑No
1
PROPERTY INFORMATION
Existing use of property:Second home Intended use of property:Second home
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes IONo IF YES, PROVIDE A COPY.
R Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code, APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone
Ordinance of the Town of Southold,Suffolk,County,New York and other applicable Laws,Ordinances or Regulations,for the construction of buildings,
additions,alterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable laws,ordinances,building code,
housing code and regulations and to admit authorized inspectors on premises and In building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 210.45 of the New York State Penal Law.
Application Submitted By(prin ):Leor Shapiro A 'zed Agent BOwner
Signature of A licant: -" pate:
g pp
STATE OF NEW YORK)
SS:
COUNTY OF Nassau )
Leor Shapiro being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the Owner
(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
oe
15�'-d ay of CAja usf 20 a/
Notar ublic
ANITA :ELI�ZABETH :NewMAN
NotaryEa -State of ork
PROPERTY OWNER AUTHORIZATION ,01GUO0138(Where the applicant is not the owner) Quad in Nassau My Comsion pires 2027
I, residing at
do hereby authorize to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
Owner's Signature Date
Print Owner's Name
2