HomeMy WebLinkAbout52359-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#: 52359 Date: 10/15/2025
Permission is hereby granted to:
Harry loannou
102 Boulder Rd
Manhasset, NY 11030
To:
Demolish an existing single-family dwelling and deck(by Southold Town definition) and construct a
new single-family dwelling with HVAC system and pergola addition as applied for per SCHD approval.
Premises Located at:
635 Stanley Rd, Mattituck, NY 11952
SCTM# 106.-8-14
Pursuant to application dated 09/11/2025 and approved by the Building Inspector.
To expire on 10/15/2027.
Contractors:
Required Inspections:
Fees:
DEMOLITION $230.00
Single Family Dwelling-NEW $3,119.00
CO Single Family Dwelling-New $100.00
Total $3,449.00
Building Inspector
TOWN OF SOUTHOLD—BUILDING DEPARTMENT
!: Town Hall Annex 54375 Main Road P. O. Box 1179 Southold,NY 11971-0959
.1
� Telephone (631) 765-1802 Fax (631) 765-9502 httia :/:�wrw. outholdtonny. o
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
C u
PERMIT NO. J of r59 Building Inspector,
SEP 1 1 22
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an III :"f`vr°tnoa
Owner's Authorization form(Page 2)shall be'completed.' "lc i of f o vthoiej
I
Date:
OWNER(S)(O�F PROPERTY: r` /-
Name; �0 �✓l��'`� SCTM # 1000- L+
Project Address:
Phone#: 1 - 1{.) Email: H T-4)A IVNL' (A 2.0 V n A L. C�
Mailing Address: I U - �'�t C� s �v C, NY / i+ a 3.3
CONTACT PERSON:
w
Name:
Mailing Address: l 0i3({ 1 C�2 --CJ 1' ijL� f�i �j OSJ
Phone#: 9 17
5 ` Email: f-T%P./j-/V1VVq 2CJC-yrvf/I-:- W
DESIGN PROFESSIONAL'INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION;
Name: �� �� DLL 6;k)'CL3
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
ew Structure Addition,,, ,Iteration ❑Repair ❑Demolition Estimated Cost of Project:
[--]other O
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: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Dyes El 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 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 Gass A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
Application Submitted By(pri name): � ❑Authorized Agent ❑Owner
Signature of Applicant: "' Date:
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No. 01BU6185050
Qualified in Suffolk County
SS: Commission Expires April 14,
COUNTY OF )
being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the
(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
f �
J LLtA � �' G
t day of 20 '6"�'1
Notary Public
PROPERTY OWNER AUTHORIZATION
(Where the applicant is not the owner)
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
I I�iz�,� l�1tY�/rVL,�1A
Print Owner's Name
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esign Professional's Certification Required. Abandonment Of the existing sanitary system must
Submit P.E. or R.
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tion and Construction of the Sewage disposal System Submit completed form vvVVM-080 as proof
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U F FO LK C�U►�Ty EPAi TIUIENT OF HEALTH SERVICES ,
PERMIT FOR APPRO AL OF CONSTRUCTION FORA 1
INGLE FAMiLy RESIDENCE A
ND
CABANA
R-25-0330
DATE 311 212025
H .S. FIEF. No. �
PPROVEfJ
ToTAiL IMU M 0M 6/0
EXPIRES THREE
YEAR FROM DATE OF APPROVAL