HomeMy WebLinkAbout52601-Z TOWN of SOUTHOLD
BUILDING DEPARTMENT
G
SOUTHOLD, NY
'I"
141
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#: 52601 Date: 01/09/2026
Permission is hereby granted to:
Perciballi M Irry Trt
325 Van Cott Ave
Farmingdale, NY 11971
To.,
Construct a detached garage with second story storage loft accessory to an existing single-family
dwelling as applied for.
Premises Located at:
840 Windjammer Dr,Southold, NY 11971
SCTM#79.-4-67
Pursuant to application dated 11/08/2025 and approved by the Building inspector.
To expire on 01/09/2028.
Contractors:
Required Inspections:
Fees:
Accessory-New structure $941.00
CO Accessory Structure $100�010
Total mo
Building Inspector
" TOWN of SOUTHOLD--BUILDING DEPARTMENT
Town Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
n�
Telephone(631) 7�5-18U2 Pax(631) 76S�-9S02 too yo o
Date Received
APPLICATION FOR BUILDING PERMITE C E
I,
For Office Use Only
PERMIT NU. Building Inspector R �
8011d"Ing Department
Applications and forms must be filled out in their entirety. incomplete 1own of
a
utold
applications will not be accepted. ''Where the Applicant Is not the owner,an ���
pp �' PP
Ownees Authorization form(Page" )shall be completed. I
Date:April 25th, 2025
OWNER(S)of PROPERTY:
Name:Michele Perciballi SCTM#1000-79.4-57
Project Address:840 Windjammer Drive, Southold, NY 11971
Phone#: 631 694-2453 1 Email:adam@ripiprecision.com
Mailing Address:92 Toledo Street, Farmingdale, NY 11735
CONTACT PERSON:
Name:Jake LaChapelle
Mailing Address:P.O. Box 1251, Mattituck, NY 11952
Phone#: 545 251-5058 T—Eirn a i I:jake@lachapellearchitecture.com
DESIGN IGN PROFESSIONAL INFORMATION:
Name:Jake LaChapelle AIA
Mailing Address:P.O. Box 1251 Mattituck, NY 11952
.......------------------
Phone#:(646) 251-5058 Email:jake@lachapellearchitecture.com
CONTRACTOR INFORMATION:
Name:tbd
Mailing Address:
Phone#: Email
DESCRIPTION of PROPOSED CONSTRUCTION
New Structure MAddition ❑Alteration ❑Repair M Demolition Estimated Cost of Project:
�1 Other oo,000
Will the lot be re-graded? ❑Yes No Will excess fill be removed from premises? ❑Yes RNo
1
..... Now
L
PROPERTY INFORMATION
Existing use of property:single-family res, intended use of Property:no change
............................................
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
AC I this property? []Yes 5iR No IF YES.. PROVIDE A COPY.
S, Check Box After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water issues as provided by
Cha pter Z36 of the Town code. APPUCATI ON I S HEREBY MA DE to the Building Depa rt me nt f a r the Iss uance of a 8 ui Iding,Perm it pursua nt to the Build ing 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 premlses 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 Submifted By J' r", m, .Jake LaChapelle RAuthoritzed,Agent 00wner
�p I
Signature of Applicant: te:
Da
C 11 ONNI I�'E 1-1 D-�9UNGH
vate of Nm'York
STATE OF NEW YORK) Notat'Y'PubllC,St
No.0 1 BU 61,850 5'0
SS: ()u,alIfied In Suffol"k COuntY
4t JD4%le
COUNTY OF Suffolk Co,mmi,s,�si�on,Exp,'re,,sA,Prll 'I 2:
Jake LaChapelle
being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
Nhe 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
Id,��'y Of
------------------
Notary Public
PROPERTY OWNER,AUTHORIZATION
(Where the applicant is not the owner)
92 Toledo Street, Farmingdale, NY 11735
Michele Perciballi siding at
re
do hereby authorize Jake Lau'hap&-%elle to apply on
'�outhold Building Department for approval as described herein.
W
my b,eba1f,','t'6 the
W s Signature Date
Michele Perciballi
Print Owner's Name
I.......... 2