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Home My WebLink About9196-zTO~N OF $OUT~OLD BUILDING DEFARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 9196 Z Permission is hereby granted to: at premises located at ..T~.,Z.~s...,/e.S~..C-~.~...~ve ................... ~. ........................................... : ............... .................................................. g.u:~..h~3~.e ....... N.,-I:, ............. ,. ........... :....: ....... '..: ...... ' ........................ pursuant to application doted .............. : ......... ~-~i'~ ....... ~{) ...... 7 19_. , i~d 'proved by th~ :' _ Building Inspector. Fee $.J.,~.,.~..Q ........... /~op roved TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ^pp,,cot,on .............. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS Date April 20 19.~.?. .... a. Th~s application must be completely filled in by typewriter or in ink and submitted in triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing Iocahon of lot and of buildings on premmes, relationship to adjoining premises or public streets, areas, and g~ving a detailed description of layout ofproperty must be drawn on the diagram which is part of this apphcatior 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 Budding Permit to the apphcant. Such perm 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 Occupanc 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 th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construchon of buildings, additions or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all apphcable laws, ordinances, building code, housing code, and regulations, and t admit authorized inspectors an premises and in buildings for necessary inspections. (Slgnd?ure of applicant, ~ name, if/a corporation) .......... li'/est ......................... Creek ~ve~ ............................ Cutcho~ue[: .......................... (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde, Owner ~,:rs F. W. Young Nome of owner of premises ................................................................................................................. (Nome and t,tle of corporate officer) Builder's L~cease No o~,y~e~ Plumber's L,cense No ................................................. Electrician's Lmense No ............................................. Other Trode's kicense ~o ............................................... 1. koc,l~on of I~nd on which proposed work wdl bo done M,p ~o ..... ~ .................. Eot No .... ~ ............ Street ~nd ~umber ...... ;]~S~..C~o~..~.e ....... ~u~elmg~ ....................................................................... Municipali~ 2. State exmtmg use and occupancy of premises and intended use and occupancy of proposed construction: a Exisitmg use and occupan~ ......... ~.~.~.~.~. ....................................................................................... b Intended use and occupancy .............................. .t~ ..... ~.~[~.Q}~.) ............................................................ 3 Nature of work (check which apphcable) New Building .......... Addition ....~ ..... Alteration ............. Repair ................. Removal ................ Demofmor. ............ Other Work ........................................... (Description) 4. Estimated Cost .................................................... Fee . .J. ~.,..0..0.. ..................................................................... (to be pa~d on filing thru apphcat~on) 5 If dwelhng, number of dwelhng units ....... .0~(~ ..... Number of dwelhng umts on each floor ......................... If garage, number of cars .............. 6. If bumness, commercial or m~xed occupancy, specify nature and extent of each type of use ........................... 7 D~menmons of ex~stmg structures, ~f any. Front ...................... Rear ................................ Depth .................. Height ........................ Number of Stones ................................................................................................. D~mensions of same structure with alterabons or addmons Front .................................. Rear ..................... Depth .........................Height ............... Number of Stones .............................. 8 D~menmons of enhre new construction Front .... ].2. ...................... Rear ..1.2. ..................... Depth ...... .1..0. ........... Height ................ Number of Stones ........ ~me ........................................... 9 S~ze of lot Front .................................. Rear .................................. Depth ............................... 10 Date of Purchase ............................. Name of Former Owner ...................................................... l 1. Zone or use distnct m which premises are s~tuated ..... ~.l.:.~-.'.L...d..i.s..~ ....................................................................... 12 Does proposed construcbon violate any zoning law, ordinance or regulation ......... ~Q ......................................... 13 Wdl lot be regraded ...... rZQ .............. Wdl excess fill be removed from premises. ( ) Yes ( ~ No 14 Name of Owner of premises ....lLuS..~.,...',& .~[olzng ............Address .......... .C..'~..q~.o.~,~.~. Phone No. ..................... Name of Architect ............................... Address ................................ Phone No ..................... Name of Contractor ..... o~r~z~. :['~m~,].y .......... Address ................................ Phone No ..................... PLOT DIAGRAM Locate clearly and dmtmctly all buddings, whether ex~st~ng or proposed, and red,cate all set-back d~mensions fror property hnes Gwe street and block number or description according to deed, and show street names and ind~cat ..... z ...... ........ .............. (Signature of op,,?cant) / Sworn to before me this ............... ~'.Q. day of ............ ~t~!~PYJ.~ ...... , 1c) Suf~oik Notary Publ c, -~...~,.~ ............ ~ ......... ,, ............. County ELIZABETH ANN NEVILL~ NOTARY p~,r,,:C State or New YorR No. 52 812o3.,2, Suffolk term Expires t**~'rch 30, 1 STATE OF NEW YORK. COUNTY OF .S.. ff.olk ........... S .................. i.1:..~. ])'.,h/,~]~§ ..................... being duly sworn, deposes and says that he is the apphcar (Name of individual signing contracf) above named He as the ................................. .O.?,rlle..z:, .-:b..u.i.]....d.e...:R. ............................................................................................ (Contractor, agent, corporate officer, etc) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and fd thru apphcat~on; that all statements contained ~n this apphcchon ore true to the best of h~s knowledge and behef; an tk, a~ the work will be performed m the manner set forth in the apphcat~on filed therewith.