HomeMy WebLinkAbout52841-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#: 52841 Date: 04/07/2026
Permission is hereby granted to:
Terence Leavay
75 Cedar Dr
Southold, NY 11971
To.
Construct additions, alterations and an attached carport to an existing single-family dwelling as
applied for.
Premises Located at:
75 Cedar Dr, Southold, NY 11971
SCTIVI#78.-7-45.1
Pursuant to application dated 02/05/2026 and approved by the Building Inspector.
To expire on 04/06/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Addition&Alteration $695.00
CO Single Family Dwelling-Addition/Alteration $100.00
Total $795.00
Building Inspector
� OF UUT CJLD--BUILDING DEPARTMENT
TOWN
ry4 Tovvn Hall Annex 54375 Main Road P. 0. Box 1179 Southold,NY 11971-0959
Telephone 631) 765-1802 Fax (631) 765-9502
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector— _ ,,, 20216
i
Applications and farms must be filled out in their entirety. Incomplete µ
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shah be completed.
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Date:2020.01.28
OWNER(S)OF PROPERTY.
11
Name:Dale & Terence LeavaY SCTM# 1000-78.-7-45.1
Project Address:75 Cedar Drive, Southold, NY 11971
Phone#:(031) 484-7287 Email:missdale@optonline.net
Mailing Address:75 Cedar Drive, ,Southold, NY 11971
CONTACT PERSON:
Name: Jake LaChapelle A1A
Mailing Address: P.O. Box 1251, Mattituck, NY 11952
Phone#: 640 251-5058 Email.jake@lachapellearchitecture.com
DESIGN PROFESSIONAL INFORMATION:
Name: Jake LaChapelle AIA
MailingAddress: 11952
P.O.PCJ Box 1251, Matt�tuck,
Phone#: 640 251_5058 Email:jake@lachapellearchitecture.com
CONTRACTOR INFORMATION:
Name:
Mailing Address.-
Phone#: Email
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure DAddition DAlteration CCl Repair ❑Demolition Estimated Cost of Project:
❑0the r
$150,000
Will the lot be re-graded? ❑Yes on No Will excess fill be removed from premises? ❑Yes RN No
1
..................
IN "'W"N
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-40 this property? F]Yes *No IF YES, PROVIDE A COPY.
9 Chieck Box A e r Rea di rig: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter 236 of the Town Code. APPUCA71ON 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 demoUtion as herein desaibed.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 Class A misdemeanor pursuant to Section 210AS of the New York State Penal Law.
Application Submitted By lk,Jake LaChapelle AIA WAuthorized Agent " ElOwner
Signature of Applicant, Date
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEW YORKI No.01 BU6185050
SS: Qualified in Suffolk County
COUNTY OF Commission Expires Apr11 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 (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
o,
day of 20 c�Aqo
C/ Notary Public
PROPERTY OWNER AUT'H'ORIZATION11
(Where the applicant is not the owner)
I/ Dale Leavay I residing at 75 Cedar Drive, Southold
NY 11971 do hereby authorize Jake LaChapelle to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
1/29/2026
A
OWe-ells S!, re Date
Dale Leavay
elo/
Print Owner's Name (Li
2
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