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Home My WebLink About1653-z FOI~IU[ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 1653' Z Date ........... ~l~diLt~....~ ............... 196~... Permission is hereby granted to' ...~r~r~e~l ...................................... to ~4..~..~...~y., ~.~ ................................................................................. ~t premises [~ated at ..~~.,~ ........... ~~ ......................................................... pursuant~to applicahon dated ....................... ~~ ..... ~ ......... 1~,..., and approved by the Budding ,Inspector Fee $~ ........... FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Mop No. ~ Block No. ~*~ Lot No. confor~ substantially to the Apphcotion for Buddin~ ~rmit heretofore filed in this office d~ted doted ........ ~.~...~ ................... , 19...~, was ,ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this ce~ificate is issued is ........ ~e certificate is issued to NiCk ~rSiCh, (o~er, lessee or o~ the o{oresoid building. FOR~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ........ Approved ............................ , 19 ....... Permit No ............................. Disapproved a/c ....... ~~ ........ (Budding/Inspector) Apphcat~on No..,./..~.....~....~ ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s apphcation must be completely filled ~n by typewriter or ~n mk and subnmtted in duplicate to the 13uddm Inspector. b. Plot plan showing location of lot and of buddings on premises, re[ahonsh~p to odlo~ning premises or public streets areas, and g~wng a detailed descnphon of layout of property must be drawn on the diagram which is part of this apphcat~or c The work covered by th~s apphcation may not be commenced before ~ssuance of 13uddmg Permit d Upon approval of this apphcation, the 13u~ldmg Inspector will ~ssue o 13uddmg Permit to the applicant Suc permit shall be kept on the premises avadable for inspection throughout the progress of the work. e No budding shall be occupied or used in whole or in pa rt for any purpose whatever untd a Cerhficate of Occupanc shall have been granted by the 13uilding Inspector. APPLICATION IS HEREI3Y MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to th, Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o Regulations, for the construchon of buildings, addihons or olterahons, or for removal or demoht~on, os hereto described The apphcant agrees to complywith all apphcable laws, ordin~~ c~ 1~ ..... (Address of State whether apphcont ~s owner, lessee, agent, architect, engineer, general contractor, electnoan, plumber or budder ................................................................. .................................................................................. Name of owner of premises ..........., /l~...~... .~,~x~..,~..~ ..................................................................... If opphcant is a corporate, s~gnature of duly authorized officer (Name and t~tle of corporate officer) Location of land on which proposed work w~ll be done Map No .............. ,,..'"....':. ......... Lot No . ...'~. .......... Street and Number ............... - ...... ' ~., .-~_~.-~,~.~ .......... .~. .... ~, ... :- .................................................... Mun~opahty State ex~stmg use and occupancy of ~m~ses and ~ntended use and occupancy of proposed construchan i · ~ - - ~F.%' , , .................................................... a Ex st na use and occupancy ,,~ ~d.~..~ ,'~ ~ d ....... b Intended use and occupancy . ..-{ ~ ..: ..,"/~4~ ..'..:/../. ...................................................... 3. Nature of work (check whJch applicable)' New Building ..... ..~...... ..... Addmon .................Alteration .............. Repair .................... ,~emoval ............ Demolmon ........... Other Work (Describe) ................. 4 Estimated Cost ...... *./.-. ,~..~...(.'~., ............................ Fee ..~/~ (to'be' pa~J"~n fd,ng'~t~'i~"~l,c(~ii~i ............. 5 If dwelling, number ofdwelhng units.-~,,....-- ___~__ .,~/ ..... Number of dwelhng umts on each floor ................. If garage, number of cars ............. 4~.~'¢ ' .~ ~ ~ ~'.6 ~'C ~(~ ................................................................ 6 If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ........... 7 Dimensions of existing structures, ~f any Front ....... Rear .................. Depth ........................... He*ght ............................ Number of Stones ......... D~mens~ons of same structure w~th alterations or addmons Front ................. Rear ......................... Depth .......................... Height .............................. Number of Stones ...................................... 8 Dimensions of entire new construction Front ............. Rear ......,~...iC~'.q ......." Depth ....,.~...~,~, ........... Height ............. Number of Stones ...... 9 S,ze of lot' Front .......... /..,.~.Td) .... Rear ..... ./..~..~.. ........ Depth ./.. ...................... 10 Date of Purchase ...... ~..~...~..~ ....... Nome of Former Owner ............... ": ~ ................. 1t. Zone or use d,str,ct ,n which premises ore s,tuated.. 12 Does proposed construct,on v,o,k~'e .any ~on,ng Ipw, ordinance or'regular,on:) . .,'(/'~2 .... ~ ........................ 13 Name of Owner of premises .~.~-~f,-~.~.~.~'.../'~. Address .... *//~ .~'..~-6-;~Z'z. ~...~:~'~one No ................ Name of Architect ...,.-::~ .................... Address ....... .-~,,-~.z:.~:~.~....~.~.~'l~'onC~No ............... Name of Contractor ..~.:.~.': .~..(~,?.~...~..~.. ~ .'~'.-~>/Address, x .... '" / "/"/~.~.~:..~..~.. Phone No PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~st~ng or proposed, and red,cate ail set-bock d~mens~ons fron property hnes Give street and block numbers or description according to deed, and show street names and ~nd~cat whether interior or corner lot F STATE OF NEW.z~r'OI~,I~, ,~/ ) c c COUNTY OF ,,~.~,~.,c~. _) ~ ~ s~gnmg~at~°n)~ , being duly sworn, deposes and soys that he ~s the applican (Name of above named He ,s the ............... ~~.:~-~ (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authonzed to perform or have performed the sa~d work and to make and fll this apphcat~on, that all statements contained ~n th~s apphcat~on are true to the best of h~s knowledge and belieJ and that the work w~ll be performed ~n the manner set forth m the apphcat~gn~ded ~here~ Sworn to before, me this . ~J~ ~ ,b~,~ ~/~ // / .1, ~ ~