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Home My WebLink About2566-zFORM NO. ¢ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BERTIFIIgATE OF FIEIEIUPANEIY No ~; 2869.. Date .... .~OtObel' [9, 19 ~ THIS CERTI~ES that the bm[ding located at [/8 ~ddlO ~d Street Map No.~ Block No~ Lot No. ~ ~O~ ~ ........ conforms substantially to the Application for Bmld~ng Permit heretofore filed in this office dated .0e~ -~ , 19 ~ pursuant to which Building Permit No. 2~6 ~ dated 0~ '2~ , 19 ~ , was i~ued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~:~1 b~ld~.& .b~ ~rage t~ .................. The certificate is issued to g~. F.. ~a~ .~ ~e~tfle ~ ........ ~e~... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval [.Re ................... · ..... FO~ 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) N9 2566 Z Date ............................ 0~13e~' ....... 2a.., 19...6~ Permission is hereby granted to: .............. l~a~:~.-Roa~ ..... (Z~'A.) ...................... to ... ~-e ~t-. ~,_~.. ~at~.t te~- r~-.a...lm.~I~.. 8~o~ ag e.- tm~l~., m~d.-.aec es eer~'., t~ 9_.~cl ~,.n~.-- .... (.. ~pp~o~act ..~,¥...]Mi~,.. App eala~} ............................................................................................... c~t prem,ses located at ...~#e~.....~[~C~.~....l~.O~d~ ................................................................................. .................................................... ~t~l~..;lf. ~.~ ........................................................................... pursucnt to apphcation dated ................. (~)~ ......... .~. ............ 19.~.., cnd approved by the Building Inspector Fee $..'LO.O0 .......... ~uildi g spec~or ~ NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........~...~.~. ................ 19 ...... /. ' pprovea ........................................ , ........ ~ ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and g~wng a detailed description of layout of propertymust be drawn on the d~agram which is part of this applicatio~ c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Suc 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 Jn part For any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construction of buildings, addmons or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, ~f a corporation) .......... Y~i.cld].e..~Loe~ ....... ~o.~ol~ .............................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde O~ez· Name of owner of premises ...~,haJlJ.~....~a,~t]~l,tz~....Ga,s...sezTzJ-e~..,T~e .................................................................. If applicant is o corporate, signature of duly authonzed officer. (Nome and t~tle of c~:lrporate officer) 1. Location of land on which proposed work will be done. Map No' ....~'.._._~4~ ..............................Lot No' ...:Jf~:J¢ ........ Street and Number ...~/.~..}/~dd.'t e...l:J~D~t...g,.~,~,~.~l.....~oll~lno]4~t.~.._i~[,.], ................................................. Mumcipality 2_ State exlshng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... B.q.t;.t~Le.d...G~,s....sez'.~.:i.c~e...&..~,p~l;Ls,~e...s~q~.Qp~ ........................... b. Intended use and occupancy ...... s.e,~e....vJ,.~b,...htl~l~...s.~.o~e...~..~a.~..,CJ.1lJ, n&..eg.T~, ................ 3. Nature of work (check which applicable): New Building .... ~ .... Addition .................. Alteration ................. Repair ............. ;"7' ~emoval .................... Demolition .................... Other Work (Describe) ..................................... 4. Eshmated Cost .~......~..~..~/,..47...q....~.. ............................... Fee .... ~.0..~..0...0. ........................................................................ (to be paid on filing this application) 5. If dwelhng, number of dwelling units .... ..~..0.~ .............. Number of dwelling units on each floor ........................... If garage, number of cars .......................................................................................................................................... 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use ..... B. TJ'~.I~qJ~. ...... 7 Dm~ensions of exmting structures, if any: Front ..........................Rear .......................... Depth ........................... Height ............................ Number of Stories .............................................................................................................. D~mensions of same structure w~th alterations or addihons: Front ................................ Rear ............................... Depth .............................. Height ...~,,,.., .................... Number of Stories ......................................... ~±ag 92 ~ 22 16 _ 8. Dimensions of entire new construction: Front .~.~...t~.......~. .........Rear ............................ Depth ........... ~, ........... Height ............................ Number of Stones ....... ~)~. .............. 9. Size of lot. Front ...... ~,,.O.Q .............. Rear ....... 1.):f~ ............. Depth ..,2.9..~..~./.~ ............ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use district m which premmes are situated...~!J3!!...dJ.s.t, .......................................................................... 12. Does proposed construchon violate any zoning law, ordinance or regulation? ..~.8. ........................................... 13. Name of Owner of premises .~.,.[,.~.~:D.U,~...Ga~s.A~i~I~o.e...Z~o, ............................. Phone No .................... Name of Architect ...?..h..~.~$t).~...~..~.~.P.;l,l~,~110 ........ Address ,Ba~.~e,:b.tsTc'J.~l I e...0k'l-~hone No ................... Name of Contractor " " .................................................... Address ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-bock dimensions flor property hnes. Give street and block numbers or description according to deed, and show street names and indicat whether interior or corner lot. gee filed plans STATE OF NEW YORK_ ) COUNTY OF ............ f S.S. above named. He is the ..... (~g,f~~ ...................................................................................................................................../ (Contractor, agent, corporate officer, etc.) of sa~d 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 this application ore true to the best of his knowledge and bell and that the work will be performed in the manner set forth in the application filed therewith. Sworn~e meth,s ~ ~ . · ' · ____ _ ....~..~(_~.~ay of...~~ ............. , 19.~ ~ ~ ~ ~ ~.. ~' ~' Nota~ PubJi~..~.~ ......... a~;~q~'_ . (Signature of applic~t) ~ ~ ~otary Da~.~c, StYe o~ New ~or~ 3 6 7 I i i i i ¢' CHA?N' zhvK KX/ STbVG COA/CIPK ?-I- ~(I S T/N b A D D~ V~LOPI~£N T F H PHILLIPS PE'TROLEUM COMPANY BA RT~dEPvgLLE, OKLAHOMA ~£ 0 T ~Z A/V VAI~ ObZ£t~ GAS S£PVIC£ , Z/CC. 80UTHOL~ , L,Z. ~ ,4/£VV YOi~I< J 6 7