HomeMy WebLinkAbout47081-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
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#: 47081 Date: 11/412021
Permission is hereby granted to:
1925 Grandview Inc
109 Stratford Ave
Garden City, NY 11530
To: legalize"as built"generator as applied for.
At premises located at:
1925 Grandview Dr.,Orient
SCTM#473889
Sec/Block/Lot#14.-2-3.21
Pursuant to application dated 101112021 and approved by the Building Inspector.
To expire on 5/812023._
Fees:
AS BUILT-ACCESSORY $200.00
ELECTRIC $170.00
CERTIFICATE OF OCCUPANCY $50.00
Total: $420.00
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EiIildi spector
y 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 r ;`'ct ;.s holdio4�ter,=
Date Received
APPLICATION FOR BUILDINGPERMIT
For Office Use Only
PERMIT NQ. ( 1 Building Inspector UU LL' ti
Applications and forms must be filled out in their entirety.incomplete 0= I i
applications will not be accepted. Where the Applicant is not the owner,an
Owner's Authorization form{Page 2}shall be completed. BUILDING DEPT
;OWNOF:BOUTHO D
Date:
OWNER{S}OF PROPERTY:
Namur -`= f r""` U'0 i SCTM#1000
f Project Address = ,
Imo{ __ �j(f`
Phone#: Email:
Mailing Address:
CONTACT PERSON:
Name: f
/mac
Mailing Address r J -
l 1 1{
Phone#: > Email:
r m
1 DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR INFORMATION:
Name:
I Mailing Address: [
Phone#: Email:
I
DESCRIPTION OF PROPOSED CONSTRUCTION
i
ONety tructure ❑Addition OAlteration ❑Repair DetC}lition Estimated Cost of Pro'ect:
= 1
is Cher r � t r '
Will the lot be re-graded? ❑Yes O Will excess fill be removed from premises? Dyes o
I
1
PROPERTY INFORMATION
Existing use of property: , n Intended use of property:
Zone or use district in which premises is situated: Are there any covenants andjestrictions with respect to
this property? ❑Yes--, o IF YES,PROVIDE A COPY.
ET'Clh=Ck Box After Readin.. 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,
i 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{printn me}: 1 -Authorized Agent ❑Owner
Signature of Applicant; -- Date: _ —26
STATE OF NEW YORK)
5:
C0UNTY0F ,i Avflf ) z )
{� o e, ri being duly sworn,deposes and says that(s)he is the applicant
(Name of individual signing contract)above named,
(S)he is the 1,
(Contractor,Agent,'Corporate Officer,etc.)
of said owner or owners,and is duly authorized to 'm 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
oq day of .202-1 {`1f U A 1►1 t� A
_' Notary Public
TRA C-t -
-
y _K
-.PROPERTY ON R UTHO =ION QUALIFIED 1N, =,TY
(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
PROPERTY INFORMATION
Existing use of Intended use of property: !L
property; �C(�/�Lry``CL"
i strattlor�s respect to
Zone or use district In which premises is situated: Are there any covenants anr
I this property? Oyes= o IF tE ,PROVIDE E A COPY,
as provided bVChecm Box I
Ater Reading: In..1pm%—:.wis"
236 e# T atC . -. Tit'l7+I7,5 -. tl .:- oft
-fbri _ rt - u—tim of
Law
� A rs - vs
1
Application Submitted By(print n rne)= Jed Agent []Owner
Signature of Appritarl Date: 11�7_
STATE OF NEW YORK)
SS:
COUNTY OF 1
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
day of 217
Notary Public
EER AUTH mizATioN
(Where the applicant is not the Owner
P,j- f
I v 2 residing at Ol A _ Z 6
tip
hereby authorise to apply on
my behalf to the Town of Southold Building pep�rtr�ent fot isprcivaI as,'described herrein.
Owner's Signature
Print Owner's Name \ \\
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