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Home My WebLink About2186-zFORM NO, 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE rnF EIP. P. UPANP. Y No. Z ,3047 .... Date ...... April.--5¢ ............. 19'68' THIS CEY¢TIF~ES that the building located at l~ln Road ....... ' ...... ,..,.. Street conforms substantially to the Application for Building Permi~ heretofore filed i~,this office. dated ....... '8~gi '~3', .... 19.65. pursuant to which Building Permit, No. ~f,,... dated ....... Sept;' 'I3; ..... " 19.63, was issued, and conforms to all 0'( the.x ; reCUire-t, ~-, merits of the applicable provisions of the law. The occupancy for which this issued is .............................................................. ~..J ...... p~ivate one ~amily ~elling t,' ,' The certificate is ~ssued to ............................................. .,/: ;.. - .~. · of the aforesaid building. ? ?~' Suffolk County Department of Health Approval . .~ ...[K,_* ............ [. [,,~. :.-,~.. f * '~Dl~llOll2g mspee~or, FOl~l~f NO. 2 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? 2186 Z Date ................. .~..e. ~.~ ~.~]2..e. ~f......]~ ......... 19...~.3. Permission is hereby granted to: ...... ~L.]: ~..~.~e:l ........................................ ........... .~.~,..[~:oeA ............................................... ................. L~t.t.~.~ue~ ................ ~ ......................... to ...... To" 'bttt!~"aiq" 'ad~.i¢':]: on" ~'-'an-'-e~i'~ t ~.~' "d~e']:~:i~ ............................................ at premises located at ......N/~.....~i~.,]~Oat~ ..................................................................................... .......................................... ~¢.-.ti.t~ek ........ (...~1~-.,tt.) ~.~...~,.~,. .............................................. pursUont to application doted ........ : ........... ~.~6~,...~..~. ........... A9~..., ond opproged by the Building Inspector Fee $"~i'00 ............ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~... ~..~ ....... , 19...~.~... Approved ~'x~ 19 ........ ~'ermit No. ~.~2...'.! ...~... ~ Disapproved a/c ~'_'~~'"'~"~~c~ ~- (Building Inspector) Application No...~.../....~....~?. ........... ~ APPLICATION FOR BUILDING PERMIT Date ................... ~...'~..~..~ ........ ,19..~'.~.. ......... INSTRUCTIONS o. 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 public streets or areas, and giving a detailed description of layout of property must bedrawn on thediagram which is port of this application. c. The work covered by/~his application may not be commenced before issuance of Building Permit. d. Upon approval of this oppJicotion, the BuiJding inspector will issue a BuiJding Permit to the appJicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occup~..d,, or used in whole or in pa rt for any purpose whatever uracil a Certificate of Occupancy shall hove 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 lows, ordinances and regulations. (Signature of applicant, or name, if a corporation) .... ....... .................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ..................... ~ ........ ~ ..................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ............. ~..~¢~.. ............... C-r;~.~ ........ ~ .......... .'~.....~.. ...................... Municipality ~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: o~ Existing use and occupancy ........................................................................................................ an b. Intended use and occup cy ................. ~ ...................................................................................... Nature of work (check which applicable): New Building .................. Addition ....~k ........... Alteration Repair .................... Removal .......~, .......... Demolition .................... Other Work (Describe) ........................ /~z~.c~,~.~.,~,~.g...~...~. .................. Fee (to be paid on filing this application) 4. Estimated Cost 5. If f~welling,~number of dwelling units ............. 'L ............... 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 .......... ...z~'... ........... 7. Dimensions of existing structures, if any: Front ........ ..,~....~.. ......... Rear ........ ..'~...~... ......... Depth .......... -~.....~.. Height ......... /...~. ............. Number of Stories ...................... / ................................................................... '2' ......... Dimensions of same structure with alterations or additions Front .' .......... ~...z..~.. ......... Rear ..~,.~;~'"~ De~th ........ .~..~. ............. Height .......... L.~. ................ Number of Stories ............./. .......................... 8. Dimensions of entire new construction; Front .......... ~...z....~..f./. ....... Rear ....... ~..../....~...././. ..... Depth Height ............................ Number of Stories ................ 2" ............... r ....... (...0.. ........................ ................... 9. Size of lot: Front ........... ~..0. ............... Rear Depth 10. Date of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated.. 12. Do~es proposed construction violate any zoning law, ordinance or regulation? .............. 13. Name of Owner of premises .¢¢~.~.......~ ............ Address .'2~..~.....~ ........ Phone No. Name of Architect ..... ~ ............................................. Address ............................................ Phone No. Name of Contractor ....~.. ............................................. Addres~ ............................................ Phone No. PLOT DIAGRAM Loca~e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f property lines. Give street and block numbers or description according to deed, and ~ames and indi~ whether i6terior or corner lot. ~ ~ ! STATE O~ NE~V~2OR~/, ~J_ ) S S COUNTY OFFS) ' ' ......... ~.~7~......~~ ................................ being duly !Name of individual signing al~plication) above nar~ed. He is the ....~~ .............. sworn, deposes and says that he is the applic (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and this application; that all statements contained~in tl~lr~pp, li~/~tfi/~n are true to the best of his knowledge and bel and that the work wdl' be performed in the m~r~f~*f,, az-u-~44963,f~l~br ir~t~t~r/gpplicati°nsuf~alk ca,, filed therewith. Sworn to I~efor~e' me th~s' ' ./~ ~ c0mn, ssion £x~ires ,,~rd~,.,~o ~, ~0,- 19'(~ j~ .......... dayo, ......... . . · . ........ /7 ,~ z_~/ ~J,/-c'_ /2 ~ l~-¥z~,~.~f~J,Z,~4~r~... ....... ~..~-~....'Z. .......... Notary Public,~_~...c..,~./CoLCrrdy- -~ (Signature of applicant)