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Home My WebLink About7575-z FO~M ~0, ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7575 Z Dote Z/ </.~ 7 .~7(// ........................................................ , / Y...,/.... Permission is hereby granted to: ........ ~ .......... ~.?.'.,.:..~..~i'i: .................... tO .... ;' ....................... .Z;: ...................................................... ; ............................. at premises located at ....................................................... ~.~.....-T?....¢...T...?'..~...~. .................................................................. .... ~.~.?.z....¥..z..~.L. L L~.~ ~......~.~.:~.:.z.::.....~ ~ ?.~: ~T.5 ................................................................. I --TL pursuant to application dated ................................... ~.. ........ ~../...., 19..~./..., and approved by the Building Inspector. ~ ,....?.~.51... Building Inspector FOCal NO. 1 TOWN 0~: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. Examined ~/ ~9C'7,o 77 Approvad ........................................ 19 ..... ~rmit No ..................................... o~o~a ~/~ .......................... '"'~-""'-'W,7 ~""[~ ................ ................................................ ........................ Application No. I APPLICATION FOR BUILDING PERMIT Date ............... ..................... , INSTRUCTIONS a. This application must be completely filled in by typewriter o~. in ink and submitted in triplicate to the Building Inspector, with 3 sets of plans, acgurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocmion of lot and df buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout ofproperty must be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. 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 or 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, buildings for necessary inspections. ....................... (Signature of applican.t,,~or name, if a corporation) .............. (Address of applicant)~ ,~, State whether applicant is o~;~.~, agent, architect, engineer, genera lcontractor, electrician, plumber or builder. · ............................................................................................................................. Name of owner of premises i/~d ~. d. Z~. ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License No .............................. : ...................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No ............................................... Location of land on which proposed wark~ will,be dane. /V, ap No.~v:~/~.,~.'~,~7~/~..~.~. ?LoCi kin.....(-/~ . /~ ~ ~ , ,,~ ~;~. - · ....: .......... Street and Number ...,~..~......~).....C~/~(~.~..~,~..."~. ..................................................................... ~~.' .... Municipality State existing use and occupancy of p~remises and intend,~d use and occupancy of proposed construction: a. Exisiting use and occupancy ..~L...~::J.,c,~/,w~4~;'~..] ......................................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................... Other Work .......... : ................ (De~'/~ption) 4. Estimated Cost ......................... ~..,'7,..~,...&~...~ ............... Fee .............................. /../.'.~.~.0. ............................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 6, If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........................................................ 13. Will lot be regraded ............................ Will excess fill be removed from pre. raises:.( ) Yes ( ) No 14. Name of Owner of premises /~ ............................. AddressJ.~.,~. .......... Phone No..~.fJ.~..'r...~./.,~.,~. Name of Architect .............................................................. Address ................................ Phone No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from show street names and indicate number or description accordin~Jeecb,~ ~.- ~)~ .................... -- '~ I~ property lines. Give street and block whether interior or corner lot. COUNTY OF~'¢~ ......... ['~'~ · .............................. /...~ ............................................................... being duly sworn, deposes and says that he is the applicam (Name of individual signing contracO a'bow~ named. /~ ~ ..... ~ He is the ....................... .~'~.~- · ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perfo'rm or 'hove performed the said work and to make and file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and thor the work will be performed in the manner set fo~h in the application filed therewith. Swam to be~ me this ~/) ~ ~ ~.~ day of ., ~~~...., 19~.~ ~ ~ , // .) ' ,, ,<,N / (Sian~tur~ of app cant) JOe. b2-08449°3 Suffolk Count~ JU/V.E JULY ' SHOWff HEREIN ARE FROM FIELD OB~EBVA~ONE AND/OB FROM DATA OBTAINED F~OM ' ~BDIV/SlO~4P FIL~/N FHC OFFICe- YOUNG '&' YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, HEW ALDEN W. YOUNG HOWARD W, YOUNG, SURVEY FOR: INLAND HOMES,/NC. LOT NO. 8,'"ELIJAH'S AT TOWN OF