HomeMy WebLinkAbout53071-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
SOUTHOLD, N Y
O�
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#: 53071 Date: 06/16/2026
Permission is hereby granted to:
Stephen Catalano
17 Village Hill Dr
Dix Hills, NY 11746
To:
legalize an "as built"finished basementtoan existing single-family dwelling as applied for. Additional
certification maybe required.
Premises Located at:
180 Pine Terrace, East Marion, NY 11939
SCTM#22:5-3
Pursuant to application dated 06/03/2026 and approved by the Building Inspector.
To expire on 06/15/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $2,330.00
CO-RESIDENTIAL $140.00
Total 2 430.OQ
Building Inspector
Tow F"�OUTHOLD--BUILDING DEPARTMENT
w
Town Hall Annex 5437 Main Toad P. 0. Box 1 179 Southold Y 1 1971-0959
Telephone (631)76 -1 2 Fax (631) 765-9502 l_tt wv w.southoldtownn &o_
v
Date Received
APIPLICATION
For office Use Only
s
PERMIT N0. Building Inspector.-
. �
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant Is not the owner,an
mer's Authorization form(Page 2)shall be completed.
Date.
Zo 26.06.03
OWNER(S)OF PROPERTY*
Name:Athanasios Amaxas SCTM#a.oco-2'' .- -3
Project Address:180 Pine terrace East Marion NY 11939
Phone#: 917") 217-7585 Email:tomama.xas@aadconstructioncorp.com
Mailing Address: 250 Bound Beach Drive, Mattituck, NY 11952
CONTACT"P RSON:
Name: Jake LaChapelle AIA
Mailing Address: P.O. Box 1251 , Mattituck, NY 11952
Phone#: 545 251_5958 Email: jake@lachapellearchitecture.com
DESIGN PROFESSIONAL L INFORMATION:
Name: Jake LaChapelle AIA
Mailing Address: P.O. Box 1251, Mattituck, NY 11952
i
Phone#: (646) 51_
5058 jake@lachapeIlearchitecture.com
Email:
CONTRACTOR INFORMATION:
Name:Chris Rivera
Mailing Address:°
Phone#: 515 384-9225 Email:crdonthebeach@aol.com
DESCRIPTION OF PROPOSED CONSTRUCTION
F New Stru ftu Addition FAlteration C]Repair DDemolition Estimated Cost of Project:
El Other .- $
50,000
` I
Will the lot be re graded? ❑lies No Will excess fill be removed from premises? DYes RNo
1
PROPERTY INFORMATION
Existing use of property: single-family residential Intended use of property: no change
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R 4O this property? 1JYes *No IF YES,, PROVIDE A COPY.
J9 Vilel6k Box After Rieiaidiing*, The owner/contractor/design professional Is responsible for all drainage and storm water Issues'as proyided by
Chapter 236 of the I Town Code. APPUCATION IS'HEREBY MADE to the Building Depa rtmerwif for the Issuance of a'Building Permitp"ursuant to the Building Zone
Ordinance of the-Town of Southold,Suffolk,,County,I New York and other applicable Li Ordinances orRegulations,for the construction of buildings,
additions,,alterations or for removal or demolition as herein described.,The applicant agrees to comply with all'appllcable laws,ordinances,building code,
housing code and regulations and to admit authorized Inspectors on prerises,and In building(s)fot necessary Inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to'Section 210AS of the New York State Penial Law.
w
Application Submitted By('pri" a ,,'e), ake LaC�hapelle AIA 9,Authorized Agent ElOwner
Signature of Applicant: Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01BU6185050
s S Qualified in Suffolk County
COUNTY OF commission Expires A pril 14,20C�Ff
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
day of 20 c
Notary Public
PROPERTYOWNER AUTHORIZATION
(Where the applicant is not the owner)
Ath
an as ios Amaxa residing at 14'' 3 164th Street, Wh itestion e
Y 113 5 7 do hereby authorize Jake La Chapelle to apply on
my behalf to the Town of Southold Building Department for approval as described herein,,
13 124
Owner's Signature Date
At
hanasios Amaxas
Print Owner's Name
2