HomeMy WebLinkAbout53133-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#: 53133 Date: 07/16/2026
Permission is hereby granted to:
Elise A Calabrese
15405 Route 25
Mattituck, NY 11952
To:
Legalize as-built interior alterations to an existing single-family dwelling as applied.
Premises Located at:
15405 Route 25, Mattituck, NY 11952
SCTM# 114.-6-3
Pursuant to application dated 06/24/2026 and approved by the Building Inspector.
To expire on 07/15/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $696.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $796.00
Building Inspector
a.rxA,
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 tatte 1-0
Date Received
APPLICATION FOR BUILDING PERMIT
E C E � V E
For Office Use Only
PERMIT NO. Building Inspector,
JUN 2 4 2026
Applications and forms must be filled out in their entirety. Incomplete Building Departime'rtt
applications will not be accepted. Where the Applicant is not the owner,an Town of Southold
Owner's Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: SCTM# 1000-
Project Address: L540 tAAl A( ROAD M -r(-7LA -K
Phone#:
1. 6 3 - 5 1-S a
Mailing Address:.
CONTACT PERSON:
Name: �—
Mailing Address, TULie
Phone#: S'l� _ Email: rt rC)A
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: =11
CONTRACTOR INFORMATION: ,..
Name: LIq y- i5+1 dt G K i V12— CL
Mailing Address; SOScDur C7C�c�c� ICY'tve- M.ct_++ +vAcK� M "
Phone#: c;I (o '3S4�-�,�„��
Email: c4rOn4-kc:,63-cxck C-LO(Ic.0►VX
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition Iteration ❑Re air ❑Demolition $ mated Cost of Project:
� Estimated
❑Other K
Will the lot be re-graded? ❑Yes ❑Alo- Will excess fill be removed from premises? ❑Yes
1
PROPERTY INFORMATION
Existing use of property: Intended use of property:
LGiie or use district iii�which �CmiSeSi5 Situated:`� N Are there any covenants and restrictions with respect to
this property? Dyes ONO IF YES, PROVIDE A COPY.
El Checkp Boil After Reading: The ownerjccintr ctor/design professional is responsible for all drainage and storm water issues as provided by
t hapter 236 ci the Town Mode. APPLICATION d 5 HEREBY MADE to the Building Department for the issuance of a Building permit pursuant to the Building Zone
Ordinance of4he Tdwn bf$6 tholi,Sa talk,County,New York and other applicable taws,ordinances or Regulations,for the construction of buildings,
additions,akterations or for removal or demolition as herein described.The applicant agrees to comply with all applicable lows,ordinances,building code,
housing tocle and regulations and to adrmit authorized inspectors on premises and in building(s)for necessary inspections,False statements made herein are
punishable as a Cl ss;A misdemeanor pursuant to Section 210.45 of the New York State Penal Low.
Application Submitted By(print name): C(ksez Cry I a ❑Authorized Agent KJOwner
Signature of Applicant: �ba—J2- (ICA-L'I ' Date:
CONNIE D� BUNC'M
Notary Public,State of Ne*York
STATE OF NEW YORK) No'01SU 185050
Qualified In Suffolk County
COUNTY OF
SS: COMmIssion Expires April 14, 2 ;_) �
.. being duly sworn, deposes and says that (s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the D W V4 zP
(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�
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
Print Owner's Name
2