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Home My WebLink About2346-zFOI~M l~O. 4 TOWN OF $OUTHOLD BUILDING ~IEPAETMENT ~I"OWN CLEEK'S OFFICE SOUTHOLD, N. Y, OEI~TIF'IOATE OF" OOOUF~ANOY No. ~ .25.82. Date .0.~f;~'i).e~..27.. 19~ THIS CERTIFIES that the building located at ~/~..Pe~ci£i~. ~l~:C~et~ ........ Street Map No ..... ~ .... Block No... ~.~.'. ...... Lot No ..... ~ ........ ${~t;.~.l..~.~.~]~ ,..~., .~.-.. conforms substantially to the Applicati,on for Building Permit hereto~c~e filed in this office dated .......... A~:.i].. ~l ..... 19:~4 pu.rsuant to which Building Permit No.. ~4~ .~ dated .......... $~r~.].. ~..~ ..... 19. ~.4., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy f~or which this certificate is issued is ..... ~Lttl,'~ll. g~. ~:~..£a~,i~g..~.a~,~t,~ ................................. The certificate is issued t,o ..... ~,..V~:~l¢~ .................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health App.~oval ......................................... Building Inspector FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2346 z Permission is hereby granted to: .,A o ...~a~.~l,~k. ................................................ to ....~L..:~d..,~1~.. ~-$t.~n..o~.. em.. ex~st, s.~.. ~1~t~,.~ ..................................................... at premises located at ....F~.....~.~..I~/, ...................................................................................... .................................................... ~v, att.tt~ok ....................................................................................... pursuant to application dated .......................... &.l~..1. ....... ~ ...........19..(~., and approved by the Building Inspector Building Inspector "~ FO~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................ /~ ............. , 19 Approved .................. ~ .................. , 19.....?..Permit No....~...'.~......~...~....~ .... Disapproved a/c ...... ~~ (Bu~ldin~ Irisp/r)ec~o APPLICATION FOR BUILDING FERr~V~i? 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 ad]dining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn an 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 ~ 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 part 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, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Sigr~ature of applicant, or name, if a corporation) Ave, Mattituek (Address of applicant) State whether applicant is. owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... ~mer...~...b~lde~. .................................................................................................................................. Name of owner of premises ........ ~.../~.~l,Tl,~ei.8~/J,C~ .......................................................................................................... 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 ..... ~/~.....]?aa,1,~';~o..,~t,.~ ........ I~a.~ti.tuci: .................................................. [ .......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exmtmg use and occupa cy ..... ¢l~.]L]J~%~. ............................................................................................. b. ntended use and occupancy ,~l, ll~l~t .~th s~t~at;L~n$ and...ad]~i,t~n .................. 3. Nature of work (check which applicable): New Building .................. Addition .....~ ...... Alteration ....~... Repbir .................... Removal .................... Demolition .................... Other Work (Describe) .................................. (to be paid on filing this application) ............................ Number of dwelling units on each floor ........................ 5. If dwelling, number of dwelling units Olde If g.arage, 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 Sto¢ies ........................................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ............................ Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... I~. ................... Rear .......... .~ ............... Depth ...~..~. ................ Height ............................ Number Of Stories ........ iOlli~ ............ 10. Date of Purchase ................ ~.9.~ .............................. Name of Former Owner .............. ~.~..]r...~..O.~..~. ..................... 11 Zone or use district in which premises are s~tuated .............. A.....IIL~I~.t, .............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ l~,l~. ................................. 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 fro property lines. Give street and block numbers or description according to deed, and show street names and indict whether interior or corner lot. STATE OF NEWYORI~. COUNTY OF .~'.O.,1~ ............. / S.S. ......................... ~,....~.~l:~it~ ................ .....~ ................. being duly sworn, deposes and says that he is the applicc (Name of individual signing application) above named· He is the o~t'~er - builder (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 f 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 to bbfore me this .......................... dayof ............................................ ........ ,, -- .............. ..............