HomeMy WebLinkAbout48728-Z TOWN OF SOUTHOLD
BUILDING DEPARTMENT
m 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 #: 48728 Date: 1/12/2023
Permission is hereby granted to:
Katrakazos Themis
PO BOX 388
Roslyn, NY 11576
To; Install accessory stand-by generator at existing single family dwelling as applied for.
Must maintain 15 foot setback from property line.
At premises located at:
2395 Grandview Dr, Orient
SCTM # 473889
Sec/Block/Lot# 14.-2-3.18
Pursuant to application dated 11/18/2022 and approved by the Building Inspector.
To expire on 7/13/2024.
Fees:
ACCESSORY $100.00
ELECTRIC $85.00
CO-RESIDENTIAL $50.00
Total: $235.00
Building Inspector
1OWN OF SOU'I'HOLD—BUILDING DEPAKTMEN'1"
Town Hall Annex 54375 Main Road P. 0.Box 1179 Southold, NY 11971-0959
1`elephone(631) 765-1802 Fax(631) 765-9502l�sy//, wW,sq .l i towptiov
Date Received
APPLICATION FOR BUILDING PERMIT
For Office Use Only
PERMIT NO. Building Inspector.
Applications and forms must be filled out in their entirety.Incomplete `
applications will not be accepted. Where the Applicant is not the owner,an
Owners Authorization form(Page 2)shall be completed.
Date:
OWNER(S)OF PROPERTY:
Name: Th
SCTM #1000-
Project Address: 23'75 G 1-C't Vld V l&'—d d ll vP- 0 rL 4 c)(:TS- A/Y
Phone#: Email: (, -
Mailing Address: lit
CONTACT PERSON:
Name:
Mailing Address: ZG �'k/ �1 l d r�! ✓h��l `V Y ���
Phone#: 4 �`� —c�d Email: Kq �+�14QZuJ i� �f0 . Cb 1�)
DESIGN PROFESSIONAL INFORMATION:
Name:
Mailing Address:
Phone#: Email:
CONTRACTOR) INFORMATION:
Name: — — \ V ILKQ Zv� 1
Mailing Address: Vtll� l �S�'P✓ 9J✓(.ve Y)'l4 l'I 1 /t/ W
Phone#: A '� 2cl s—U w3 Email: :iLq+V Ie-1g26 QQ cto . coy I
DESCRIPTION OF PROPOSED CONSTRUCTION
�,,t�� �.t � i. C�.._rn r Estimated- � Cost of Project:
❑New.cite acture ❑Addition El I er +inn r De lit n_n
' Oter rC ^�CC�
Will the lot be re-graded? ❑Yes No Will excess
g a fill be removed from premises? ❑YesN0
1
b
PROPERTY INFORMATION
Existing use of property: Intended use of property:
I
Zone or use district in which premises is situated: Are there any covenants and restrictions with respect to
this property? Dyes +io IF YES, PROVIDE ACOPY.
lC.beck BOX After Reading: The owner/contractor/design professional Is responsible for all drainage and storm water Issues as provided by
h."rF236 of the Town Code. APPUCATION 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): I I rc.{�Cq L� ❑Authorized Agent ❑Owner
Signature of Applicant: - -w.w Date:
CONNIE D.BUNCH
STATE OF NEW YORK) Notary Public,State of New York
No.01 BU6185050
55:
Qualified in Suffolk County
COUNTY OF ......... } CoMmission Expires April 14,2�
_..........,being duly sworn, deposes and says that(s)he is the applicant
Name of individual signing nin g g con a
tract)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
�.... � oday of.....�D VC,� � �' _ .._...�.._--- . .�_
20
Notary Public
(Where the applicant is not the owner)
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
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