HomeMy WebLinkAbout52600-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
�o
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#: 52600 Date: 01/08/2026
Permission is hereby granted to:
Fernando Rodriguez
2375 Pine Neck Rd
Southold, NY 11971
To:
legalize an "as built"finished basementto an existing single-family dwelling as applied for. Additional
certification maybe required.
Premises Located at:
2375 Pine Neck Rd, Southold, NY 11971
SCTM#70.-5-51
Pursuant to application dated 01/07/2025 and approved by the Building Inspector.
To expire on 01/08/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $1,747.00
CO-R S1L�ENTIAL $100.00
Total 1847.00
nspector
TON" OF SOU THOLD--BUILDING DEPARTMENT
u Town Hail Annex 54375 Main Road P. o. Box 1179 Southold,NY 11971-0959
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Telephone (631) 765-1802 Fax(631) 765-9502 N �,
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Date Received
APPLICATION FOR BUILDING PERMIT
1 41
For Office Use Only
PERMIT NO. - Building Inspector:
JAN 7 2025
Applications and forms must be filled out in their entirety. Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
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Owner's Authorization form(Page 2)shall be completed.
Date:August 10th, 2024
OWNER(S)OF PROPERTY:
Name:Fernando Rodriguez SCTM #1000-70.-5-51
Project Address:2375 Pine Neck Road, Southold, NY 11971
Phone#: 631 506-1518 Email
Mailing Address:
2375 Pine Neck Road, Southold, NY 11971
CONTACT PERSON:
Name:Jake LaChapelle AIA
Mailing Address:P.0. Box 1251, Mattituck, NY 11952
Phone#: 531 251-5058 Email:jake@lachapellearchitecture.com
DESIGN PROFESSIONAL.INFORMATION:
Name:Jake LaChapelle AIA
Mailing Address:P.O. Box 1251, Mattituck, NY 11952
Phone#: 631 251-5058 Email:jake@lachapellearchitecture.com
CONTRACTOR INFORMATION.
Name:tbd
Mailing Address-,
� .
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
CI New Structure ❑Addition ligAiteration D Repair D Demolition Estimated Cost of Project:
C-1 Other $25,000
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes No
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. . LaChapelle Aut,h,orrize ,A, nt downer
A lication Submitted �ri name 4
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Signature of Appl�i�c� nt
Date:
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CONNIE D.BUNCH
Notary Public,State of Now York
STATE O F NEW PORK} No.01 BU6185050
SS: Qualified In,Suffolk County
COUNTY OF Suffolk Commission Expires April 14,itQy
Jake LaChapelle being dui sworn, deposes and says that(s)he is the applicant
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(Name of individual signing contract)above named,
(S)he is the
Agent
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Contractor,Agent,Corporate Officer,etc.)
to perform or have performed the said work and to make and file this
of sold owner or owners,and �s duly authorized p
application,that a p l statements contained in this application are true to the best of his/her knowledge and belief;and
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that the work will be performed in the manner set forth in the application file therewith,,
Sworn before me this
day of 2C� ������
Notary Public
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PROPERTY OWNERAU THORIZATION
(where the applicant is not the owner)
Rodriguez . . 2 75 P
lr�e Neck �`Or' dBeronica residing at
w
r
f Jake
LaChap,elle
out o r Y 171 reb authorize o apply on
dv he y ���
my behal 'to t` To of Southold Building Department for approval as described herein.
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Owner's Sign Date
Beronica Rodriguez
Print Owner's Name
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