HomeMy WebLinkAbout52861-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#: 52861 Date: 04/14/2026
Permission is hereby granted to:
845 Mill Creek LLC
160 W 88t h St Apt 1
New York, NY 10024
To:
construct alterations to an existing single-family dwelling as applied for.
Premises Located at:
845 Mill Creek Dr, Southold, IVY 11971
SCTM# 1.35.-3-36.1
Pursuant to application dated 01/09/2026 and approved by the Building Inspector.
To expire on 04/13/2028.
Contractors:
Required Inspections:
Fees:
Single Family Dwelling- Alteration $467.2.5
CO-RESIDENTIAL $100.00
Total S567.25
i ng Inspector
TC� OF CJUTHClLD—BUILDING DEPARTAMN'T
x 11 11
Town Hall Annex 54375.1V1auz Road P. +�. Box 79 Southold,1d o ,NY 971--0959
` Telephone(631) 765-1802 Fax(631)765-9502 h s://www.southoldto nn . c�
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Date Received
APPLICATION FOR BUILDING PERMIT
.00
For Office Use Only
PERMIT NO. Building Inspector
Applications and forms must be filled..out in their entirety.Incomplete �� ` �� � �n��n� 9 2 0
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applications will not be accepted. Where the Applicant is not the owner..an �
owner's Authorization form(Page 2)shell be completed.
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Date:December 19th, 2025
OWNER(S)OF PROPERTY-*
Name:845 Mill Creek LLC SCTM#1000-135.-3-36.1
Project Address:845 Mill Creek Drive, Southold, NY 11971
•
Phone#r Email:
Mailing Address:1 60W 88th St, Apt. 1, New York, NY 10024
CONTACT PERSON:
Name:Jake LaChapelle AIA
Mailing Address:P.O. Box 1251, Maftituck, NY 11952
Phone#:(646) 251-5058 Email:jake@lachapellearchitecture.com
DESIGN PROFESSIONAL INFORMATION:
Name:Jake LaChapelle AIA
Mailing Address:P.C . Box 1251 Maftituck, NY 11952
Phone#:(646) 251-5058 Email:rake lacha ellearchitecture.com
............
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CONTRACTOR INFORMATION:
Name:
Mailing Address:
i
Phone#: Email:
OWN NNN
DESCRIPTION OF PROPOSED CONSTRUCTION
• moliti n Estimated Cost of Project:
❑New Structure ❑Add�tron Alteration ❑Repair ❑De o
El Other 1+oa,aoo
Will the lot be re-graded? ❑Yes iR No Will excess fill be removed from premises? F]Yes 9 No
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'Mill moo"'11",
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
F -40 this property? FlYes W No IF YES.,PROVIDE A COPY.
W Check BoxAfter Reading,.* "rhe"ner/contractor/design professional b responsible for all drainage and storm waw Issues as-provided by
Chapter 236 of the-Town Code. AP.PucATION[S�OE'REBY MADEto the Building Department for the issuance ofa 13611ding-Fermit:purttiant to the Ouilding Zone I
ounty, York and other applicable Laws,Ordhmni s or-Re
Ordinance ofth,6 irowh of Southold,,Suffolk C gulations,fbr the construction of Wildin'm
additions,alterations or for removal or demolition as herein described.The applicant agrees to con ply with all applicable laws,ordinances..,.b.pilding,code,
housing code and regulations''cind to admit authorized-*inspectors on-premises and In building(s)for necessary Inspections.False statements mad6 herein are
punishable as'a Class Xmlsdemennor pursuant to Section 210AS of the New York State Penal Law.
,,Jake LaChapelle AIA
Application Submitted By(print natri @Authorized Agent El Owner
Signature of Applicant: Date: 1.,E
CONNIE D.BUNCH
Notary Public,State of New York
STATE OF NEWYORK) No.01BU61185050
SS: Quallfied In Suffolk County
Commission Expires AprIl 14,
2��
COUNTY OF
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
v _day of tO Ir q 20 cz),9 C4)
Notary Public
P,ROiP,ERTY'OWNER ,AUTHOR.I'ZATI'ON
(Where the applicant is not the owner)
'Jo rdan D ra h m a n residing at 160 W 88th Stl Apt. 1, New York, NY 10024
do hereby authorize Jake LaCha elle AIA to apply on
my behalf to the Town of Southold Building Department for approval as described herein.
0,
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Owner's Signature Date
Jordan r hrn n
Print Owner's Name
2
Mill
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