HomeMy WebLinkAbout53225-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#: 53225 Date: 08/24/2026
Permission is hereby granted to:
David G Purinton
1350 Rocky Point Rd
East Marion, NY 11939
To:
legalize "as built"window and door replacements to an existing single-family dwelling as applied for..
Premises Located at:
1290 Rocky Point Rd, East Marion, NY 11939
SCTM# 31.-2-15
Pursuant to application dated 08/11/2026 and approved by the Building Inspector.
To expire on 08/23/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
CO- RESIDENTIAL $100.00
IdTotal 600.00
--- Building Inspector
` '"rF°� 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 h1tR : WWW.soutl1oldtgApp . Qy
Date Received
APPLICATION FOR BUILDING PERMIT
j For Office Use Only
PERMIT NO. 5Building Pnspectar, AUG 1 1 2026
Applications and forms must be filled out in their entirety.Incomplete Building Department
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.
OWNER(S)OF PROPERTY:
Name: SCTM# 1000-
Project Address;
w aqq 6I n 4 £use u .
Phone#: lVJO $ $ 5J Email:m0lf��'�S(� UY" �fl�"On a 0{ • Gc7m
Mailing Address: �G m
CONTACT PERSON: tt
Name: (� -9, ut5 oy
Mailing Address:
Phone#: Email:
DESIGN PROFESSIONAL INFORMATION:
Name: n()n-c',
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name: S e,W
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
[]New Structure C3Ad9t+-
ion OAlteration G Pepair ODemolition Estimated Cost of Project:
❑Other $
Will the lot be re-graded? []Yes El No Will excess fill be removed from premises? ❑Yes ONO
5 p►�zee,T �t.�AG�xv►� ° win Do�� � ° � x 3'� � x ,�� x��
�3 D►a�.cr ���rc,� � �'�. �� cai� � : Par��l v pglri� �
( 6 f, -60 41 ® 35 11,1-Sot,C�-10"X-3-5" - r� ya) ,S-
PROPERTY INFORMATION
Existing use of property: Intended use of property:
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? ❑Yes ❑No IF YES, PROVIDE A COPY.
0 Check Box After Reading: The owner/contractor/design professional is responsible for all drainage and storm water issues as provided by
Chapter Z36 of the Town Code. APPLICATION 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 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 premises and in building(s)for necessary inspections.False statements made herein are
punishable as a Class A misdemeanor pursuant to Section 220.45 of the New York State Penal Law.
Application Submitted By (print name):Tnoyi e, D�. ur ' ❑Authorized Agent ❑Owner
I Yl rl
Signature of Applicant: Date:
ONNIE D. BUNCH
Notary Public,State of New York
STATE OF NEW YORK) No.01BU6185050
SS: Qualified 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
}
G ay of 2 0 C
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