HomeMy WebLinkAbout53244-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#: 53244 Date: 09/02/2026
Permission is hereby granted to:
Patricia E Peck
155 Primrose Rd
Williston Park, NY 11596
To:
Legalize as-built window&door in-kind replacements on an existing single-family dwelling as applied
for.
Premises Located at:
782 Bailie Beach Rd, Mattituck, NY 11952
SCTIVI#99:3-5
Pursuant to application dated 08/17/2026 and approved by the Building Inspector.
To expire on 09/01/2028.
Contractors:
Required Inspections:
Fees:
As Built Alteration $500.00
CO Single Family Dwelling-Addition /Alteration $100.00
Total $600.00
-JU&
Building Inspector
tF r 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 htt: s://www.southoldtownn ov
Date Received
BUILDINGAPPLICATION FOR
For Office Use Only F C U E
PERMIT NO. Building Inspeeton
Applications and forms must be filled out in their entirety.Incomplete
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form(Page 2)shall be completed. qAt'-d 1 + ?tf
Date:8-3-26
OWNER(S)OF PROPERTY:
Name:Patricia Peck SCTM#1000-99-3-5
Project Address:782 Bailie Beach Road, Mattituck
Phone#:c/o Pat Moore Email:pcmoore@mooreattys.com
Mailing Address:
CONTACT PERSON:
Name: Pat Moore
Mailing Address:51020 Main Road, Southold NY 11971
Phone#:631-765-4330 Email:pcmoore@mooreattys.com
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
Mailing Address:
Phone#: Email:
DESCRIPTION OF PROPOSED CONSTRUCTION
❑New Structure ❑Addition *Alteration ❑Repair ❑Demolition Estimated Cost of Project:
❑Other in kind and in place windows&doors @1980(for pre-CO application) $500
Will the lot be re-graded? ❑Yes '®No Will excess fill be removed from premises? ❑Yes *No
1
PROPERTY INFORMATION
Existing use of property:2 existing dwellings Intended use of property:same
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
R-40 this property? DYes 50 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 236 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 210.45 of the New York State Penal Law.
Application Submitted By(primt-n 0 av-R IRAuthorized Agent 00wner
Signature Of Applica : Date:
17 e
STATE OF NEW YORK)
SS:
COUNTY OF
fl2h IM a C mrie3 being duly sworn, deposes and says that(s)he is the applicant
(Name of individual signing contract) above named,
(S)he is the YU-U
(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
day of
20 2l9
Notary Public
MADISON MESSINA
PROPERTY OWNER AUTHORIZATION NOTARY PUBLIC,STATE OF NEW YORK
(Where the applicant is not the owner) Registration No.0 1 ME0002865
Qualified in Suffolk County
Commission Expires Mareb I 7,M
Patricia Peck residing at 782 Bailie Beach Road, Maftituck
NY 11952 do hereby authorize Patricia C. Moore 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
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