HomeMy WebLinkAbout1857-zFORM i~0. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
'I"OWIN CLEEK'S OFFICE
SOUTHOLD, N. Y.
BERTIFIP. ATE: [::IF rlI~P. UPANP. Y
THIS CERTIFIES that the building located at ~/~.ia~ .]~O~c] ................. Street
Map No.. ~.~'~.~teS.. Block No.X~Z ......... Lot No.. ~L~ ....... ~&t.~lt~Ck.r ,~..Y .....
conforms substantially ~o the Application for Building Permit heretof,~re filed in this office
dated ...... ~c~.t~St:..23, ........ 19~2. pursuant to which Building Permit No. 3.~?. ~;.
dated ...... ~U9O~;. 22 ........ 19.62, was issued, and conforms to all of the require-
ments ,of the ,applicable provisions of the law. The ,o,ccupancy f, or which this certificate is
issued is ...~.e.w.. 9.~..e..t~..~n.~.i.l.y..~.~.e.], .~.i~r~cj ............................................
The certificate is issued t,o . .I~t~,1~O1~,~ .~or4~.~r~ir~o ...............................
(owner, lessee or tenant)
of the aforesaid building.
,Suffolk County Department of Health Approval ..... .~..~.~.~.h. ~..$~).6.4 .....................
Building Inspector~.~
FOI~M NO. 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N.° 1857, z
Date .......................... ~S~'"'~.I~ ........ 19.~..
Permission is hereby granted to:
lltet~.:l, es..~o~.t.a~$~ .......................................
· .b~01. ....... 2~st"Ave .......................................
........ · stol-~a..-~-i...~;.¥.s .....................................
to ..... lh~.]-d., new" one' ' '$mnl']'~r ' 'dwe'~ .~'ing .................................................................................
ot premises located ot tcrt"~"3'2'i'""Capt",~tfld"'E~a~e'~ .........................................................
......................................... N/~"~trl~"~d~ ....... ~4t~'i~U~ .........................................................
pursuant to application dated ............................. ~t~,~8~ .......~ ......... 19.~..., and approved by the
Building Inspector
Fee $ ?l'Oi'O0 ...........
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No..~t .....................
Disapproved a/c ~~~~ --
.............. ...........................................
(Building I~spector)
Date
INSTRUCTIONS
n. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or punic streets or
areas, and giving a detailed description of layout of property 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 progress of the work.
e. No building shall be occupied or used in whole or in pa rt 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, addit{ons or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply withall applicable laws, ordinances?nd regulations/TM} '
;> ........ ......................... .........
(~.g~gture of ap~nYzar~r na'~e, if a corporation)
............ ....... ....
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ............ 8 .. VzLA/-~ ...........................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed__ --~/~Y"-~/;~w°rkw be done ~M~ap No: ~'..~.'.~..~.. Lot No'..~..~ ........
·
Street and Number ./..~/~.¢~g~,~/'....x~0...~.¢.,..A~/...~-~...i ........................................................... .................. '
.... Municipaity
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing us~ and occupancy ...................................................................................................................................
b. Intended use and occupancy 12~-G.
3. Nature of work (check which applicable): New Building ....~... ......... Addition .................. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe)
4. Estimated Cost ...',7..~..0...~ ............................................ Fee ..........................................................................................
(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: FrontalS... .................. 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 ...y./. ...................
Height ............................ Number of Stor~es..,..C2./~..(~ .....................
· / / /
9. S.ze of lot: Front ......~.1~....._x ............ Rear ..... ~.~ ................. Depth .....C~.~/.~. ..........................
10. Date of Purchase .... ........................... Name of Former Owner ....~).0~./--,~....~/:~/~.~¢: ..................
11, Zone or use district in which premises ore situated ......................................................................
12. Does proposed construction violate any zonin~ 19~, ordinance or regulation? ............................
Name of Owner of prem ses~.~ '---~z~.,ftV. (~¢./:¢..~..~...,¢./~...~..~I Address ZCC./.oZ ~../¢9..¢~'iPhone No ~.~
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor .................................................... Address ............................................ Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from
property lines. Give street and block numbers or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF NEW )~fO.P,J~,
COUNTY OF .~....) '' ' , "/
.... r/~.~..~~ ..................................... being duly sworn, deposes and says that he is the applicant
' ~me ~ s~,ing a~plication)
above named. He is ~he ..~ ...... ~.~~...~.~....~.~.~.~ ......................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the s~id work and to make and file
this application; that all statements contained in this application are true to the best of his knowledge and belief;
and that the work will be performed in the, ¢fl~ReF. ¢~rth in the application filed therew th
S~orn to before me this
Notary Public, ..~~...~,.~..~, ~'"~-%-~2 ....... ,"'~ op~i~;~i'~ .............................