HomeMy WebLinkAbout52345-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#: 52345 Date: 10/10/2025
Permission is hereby granted to:
Peter Vouyoukliotis
47 Anpell Dr
Scarsdale, NY 10583
To.
construct alterations to an existing single-family dwelling as applied for.
Premises Located at:
360 Rose Ln, Mattituck, NY 11952
SCTM#99.-5-16
Pursuant to application dated 09/02/2025 and approved by the Building Inspector.
To expire on 10/10/2027.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $250.00
CO-RESIDENTIAL $100.00
Total $350.00
illding Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
p Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
A Telephone (631) 765-1802 Fax (631) 765-9502 h s://www.stttl�oldtolnov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
E
PERMIT NO. ) I10 Building Inspector:, S
i
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. T 1 n Of Southold
Date: 29th August, 2025
OWNER(S)OF PROPERTY:
Name Peter & Danielle Vouyoukliotis SCTM#1000-099.00-05.00-016.000
Project Address: 360 Rose Lane, Mattituck, N.Y. 11952
Phone#: 646.256.0145 1Email: dlcitrol15@gmail.com
Mailing Address: 360 Rose Lane, Mattituck, N.Y. 11952
CONTACT PERSON:
Name: Danielle Vouyoukliotis
Mailing Address: 360 Rose Lane, Mattituck, N.Y. 11952
Phone#: 646.256.0145 Email: dlcitrol15@gmail.com
DESIGN PROFESSIONAL INFORMATION:
Name: Nigel Robert Williamson
Mailing Address: P.O. Box 1758, Southold, N.Y. 11971
Phone#: 631 .834.9740 Email: nigel_architect@hotmail.com
CONTRACTOR INFORMATION:
Name:
Mailing Address;.
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION W i appHls DOOP. 2V rL p CE M EaT, t I J aobi
❑New Structure ❑Addition ®Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? ❑Yes WNo Will excess fill be removed from premises? ❑Yes ❑No
Ek)LAQ5eM6L)T iJ%D60 ADD1Tio0
1
PROPERTY INFORMATION
m
Existing use of property: Single Family Dwelling Intended use of property: Single Family Dwelling
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R40 this property? ❑Yes ®No IF YES, PROVIDE A COPY.
8 Check Box Afteir Reading. The owner/contractor/design professional is responsible for as 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,
housingcode 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 print name): Nigel Robert Williamson IgAuthorized Agent ❑Owner
Signature of Applicant: Date: 29th August, 2025
STATE OF NEW YORK)
SS:
COUNTY OF )
Nigel Robe Williamson being duly 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 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
29 August 25
day of 20
Notary Public
ERIK JOSEPH MCKENNA
Notary Public,State of New York
III T �� t°)
PROPERTY No.02MS6255319Qualified In Suffbik 0ounty
(Where the applicant is not the owner) Oommission Expim Fobnmy 6,NZ0
Danielle ou oukliotis 360 Rose Lane
I,
residing at
Mattituck, N.Y.. do hereby authorize Nigel Robert Williamson to apply on
my:fb1f to a wn of Southold Building Department for approval as described herein.
If 29th August, 2025
Owner gra ure Date
Print Owner's Name
2