HomeMy WebLinkAbout52291-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#: 52291 Date: 09/24/2025
Permission is hereby granted to:
Michael Tiliakos
99 Bourndale Rd
Manhasset, NY 11031
To::
Legalize as built alterations and construct additions and alterations at existing single family dwelling
as applied for.
Additional certification may be required.
Premises Located at:
1500 Stars Rd, East Marion, NY 11939
SCTM# 22.-4-14
Pursuant to application dated 08/13/2025 and approved by the Building Inspector..
To expire on 09/24/2027.
Contractors:
Required Inspections:
Fees:
As Built Addition/Alteration $948.00
CO Single Family Dwelling-Addition /Alteration $100.00
Single Family Dwelling- Addition&Alteration $493.00
Total $1,541.00
Building Inspector
"d F P Y
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
r Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
Telephone(631) 765-1802 Fax(631) 765-9502 https://www.southoldtownny.gov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector: I
Applications and forms must be filled out in their entirety. Incompleteep
Building
applications will not be accepted. Where the Applicant is not the owner,an -Town O
Owner's Authorization form(Page 2)shall be completed.
Date: 8/11/25
OWNER(S)OF PROPERTY:
Name: Kathy and Mike Tiliakos SCTM#1000- 22.-4-14
Project Address: 1500 Stars Lane, East Marion NY 11939
Phone#: 516-707-4192 Email: miketiliakos@yahoo.com
Mailing Address: 1500 Stars Lane, East Marion NY 11939
CONTACT PERSON:
Name: Katherine Samuels, RA
Mailing Address: 25235 Main Road, Cutchogue, NY 11935
Phone#: 631-734-6405 Email: Kate@samuelsandsteelman.com
DESIGN PROFESSIONAL INFORMATION:
Name: above
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
II
Name: Kyle Schadt, NFWW
Mailing Address: PO Box 1407 810 Travelers St Southold, NY 11971
Phone#: 631-298-7900 Email. kyle@NFwoodworks.com
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition ❑Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $ 250,000
Will the lot be re-graded? ❑Yes x❑No Will excess fill be removed from premises? ❑Yes El No
1
r 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 ®No IF YES, PROVIDE A COPY.
❑ 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 fade. 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 210AS of the New York State Penal Law.
Application Submitted By(print name): katherine jean samuels Authorized Agent ❑Owner
Signature of Applicant: `x'� r ` JEy"" ��``'"�`� Date: 08/11/2025
Florida JAM
STATE OF NIEW-fOft)-
SS:
COUNTY OF Miami-Dade )
katherine jean samuels being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the Authorized 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
11th day of August 20 Zb
Notary Public
Notarized remotely online using communication technology via Proof.
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
I, ( vla residing at I
Vl do hereby authorize V, to apply on
7 be to the Tow f So thold Building Department for approval as described herein,
Owner's Signature Date
ul
Print Owner's Name
2