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Home My WebLink About2218-zFORM ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. OEP. TIFIOATE OF OOO~JPANOY THIS CERTIFIES that the building located at . .t~.~,~.~...~.~.y..~..~.0.~...A.~.? ..... Street S/ S~e~ tiaven Map No ............. Block No ..... ~ ..... Lot No. ~ ...... ~OOD~Q~$~..~ ...... conforms substantially to the Application for Building Permit heretofo.re filed in this office aatea ............. ~O~.*..~.., 19.~3. pursuant to which Building Permit No...~¢~. ~ dated ............ 99~ .... ~ .... 19..63, was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The ~o,ccupancy gor which this certificate is issued is .... ?..l'.i.~.~..~...O.b.e.. ~&..m.i.~.y..d.~..e.~l:~,.f.~. g ....................................... The certificate is issued 1~o .... .~.~.~.:.L.;[..a~.. ~,...~L..~.g .................................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ..... Allg,...~.]~y. FOE~ 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) Date ....................... O~Obe~......~ ........ 19...6~ Permission is hereby granted to: R.A...l~an~o~.d.....A/C.....h~...T.....K&nl~. ................. ......... ~t~ti.tu~k ................................................. to · ...~u.i.~d. · .new.. e~e ...f-ami..~ .. ~we~ .t-~ng .................................................................................. ot premise~ located ct ...... $./.E~d...B~..~.$~ew...Ave ......... ~el, hawe~ ...................................... ...................................................... Gl~ee~po~'.t~ -..L ~..I.,. ............. ~ ........................................................ ~arsuont to op~licction dated ............................ 0~.t ............ ~. ............ 19.(~.~.., and epproved by the Building Inspector Fee $ _ ~O,,,.QO. ......... Building InspeCtor ~, ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. ............. ( ~ector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. 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 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 Deportment for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, 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 oi1 applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises ..... W..~. ,....~...~;:J,,l~g ...... : ............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .......... ~ ....................... Lot No: .................... Street and Number ...J~./.~.....J~.I~,Y...~'.~eT~..,'I~Yf) .......... IB'~ez'ha~en~.....Gr. eeztp.o.r~ ......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .'¢/~Q~.~...Ls,~ .................................................................................................... b. Intended use and occupancy ................. .O.~.~...,~.8,i~:L~...f::I,~..~;L~ ................................................................. 3. Nacure of work (check which applicable): New Building .~ ....... Addition .................. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ...~.~l..0..O...0....~../..~.. ................................... Fee ..........,],f).e..0.0. ...... (to be paid on filing this application) 5 If dwelling, number of dwelling units ................. One ...... 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....,~0. ...................... Rear ...~.0..&...]gO~.O~. Depth .... ~0. Height ............................Number of Stories....~J'~ ...................... 9. Size of lot: Front ..... ~.00...J~/m .......... Rear ..~.O0...~./M ......... Depth ...~O0..,P,~J~ ................... 10. Date of Purchase ........................................................Name of Former Owner 11. Zone or use district in which premises are situated ........ 12. Does proposed construction violate any zoning law, ordinance or regu at on? ........ J~JO ................................. 13. Name of Owner of premises ..~.,.T.K:J. rlg ................... Address ...,j~."J.O~.d~, ....................... Phone No. Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor R87 J]~l.~O:~l~ Address ~l.~'~:J.~,OJ~ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions property I'ines. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. ................................................................................................. being duly sworn, deposes and says that he is the applic¢ (Na:me of individual signing application) above named. H.e is the ..... ....... O.G~.~ ........... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and ~ this applidotion; that all stotem~RHc~nt~d in t~is application ore true to the best of his knowledge and bell and that the work will be ~ ~'t~pr set fort~ in the application filed therewith.