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Home My WebLink About2964-zFORM l~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CI~ERK'S OFFICE SOUTHOLD, N. Y. I]E~TIFll]ATE OP OI]I]UI~ANO¥ THIS CERTIFIES that the building located at E~S .lt.l~birt8ol~ .][,ial*le ......... Street Ma~r~o.°.~?. {~..Y..0."?oek No...X~ ...... Lot No..~,...r.e~.o~i~,. ~..~.. .......... conforms substantially bo the Applicati. on for Building Permit heretof~o.re filed in this office dated ............. I)~lO...2~,.., 19~. pu.rsuant to which Building Permit No. 2~6}~..~,. dated ............. D..~.d.e..~1.~.~$~.., 19~[.., was issued, and conforms to all of the require- ments ,of the .applicable provisions of the law. The .o.ccupancy ~or which this certificate is issued is Pr. irate..o~a .£ar~il~..dwol~ir~g ........................................... The certificate is issued to .Johr~. ~,. $iS.q~o .... ....... .(~q)2. ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . J~J~L$r. · .~7]~..~96~' - .by'..R,..V~l-l.~a .... Building Inspector TOWN OF SOUTHOLD BUILDING D£PARTMI~NT 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? g96 Z Date ................ Permission is hereby granted to: ................... ~'ot'mt~" '¥'T~¥~' 'L',~' · ............................ ~:~,,,~ L~r~ ~ ,_~ .................. to D~l~:3:d...n~...an.o .. ~ ~3~ .. ~.]: ~TnD ............................................ , ................ ,. ....... ; ............. ~t premises Iocoted ot ~O~'""~'~'""~Oe~:V"~IO,~"~[~ ............................ :""'; ......... '"'"'~'," :approved pursuont to opplicotion dated ..... .................... 'D~ ........~'"'"; .......19..6~., ~:nd ~ ,,u, u~u~4:n~' v ,~ns~ec*or > ' ~ Fee $.-~.0 ~ (~0 .......... - ~unaing mspector , S-9 SCHD SUFFOLK COUNTY DEPAPS~ENT OF HEALTH Date TO WHOM IT MAY CONCERN: e deed lo, cation) have been inspected by this Department and found to be satisfactory. District Engineer 'I'~)WN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined .................... :....Z ............. , A~roved ........................................ ~ 19 ....... ~ermit ~o ............................. Disapproved o/c ...................... ~: ........... ~ .................... " ......................... ~ ................................ ................................. 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 deCailed 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 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, b,u~lding code gt2d r~gulati,o~. ,J~ignature o applicant, or,~name, if a corp~,rotiopl (Address of applicant) State whe her applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ......................... . ....... .................................... Name of owner of premises ................. .~..~.'~:'.~. ............................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which~rglposed work will be d~qne. Map No.: ...... ;~ ............ ; ................... Lot No.: ._../..~.. ............. Street and Number ...~..~~......~ ............. ~.c.~.~'..,~....~.....~..~..~ ................................. Municipolj4'~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ....~.-r:~:..-~'..~.:.~ .......................................................................................................... 3. Nature of work (check which applicable): New Buildi'ng ~/' Addition Alteretion Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ~ ~ ~ ~) 0 (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 ...... ~_~r-~ ................................. . ........ 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 .... ; .................... .Z::.: ................................................................................. Dimensions of same structure with alterations or additions: Front ...... Rear Depth .......... '..,.....----~.. ............ Height ............................ Number of Stories - 8. Dimensions of entire new construction: Front .../_~.~...'./..4~.. ................ Rear ..Z~/~/...../~ ......... Depth ...~.,~'./..i: ......... Height ./.~.,~.~ ........ Number of Stories ...~ ....................... . 9. Size of lot: Front ,. ,/,¢.,~,., ............... Rear .,../...o.....o~.. .................... Depth ....~,..~..,.~. .................. 10. Date of Purchase ...~...~¢,4¢..,.../.¢../..~,~...,~... ................... Nam~ of Farm.er Owner ................................ ~ ~ 11. Zone or use district in which premises are situated ........ /...¢.~..~ ~/"' u '~' 12. Does proposed construction vioJc¢~ anwzoainalaw ordinance or reaulation? ..,~ -, -- f ne f ' ' r,~ ~~~'J~~ ' ' '"~ ........................... 13. Name o Ow r o pre~in~es,¢~,',,/,/1/~ .,4/~//. ¢~'~~''~ ........... Address~* ~' ' '"'"w~K~rt'"'""~~, ~//C;F/ /2 /'/ Phone No..~..~..~..? .,J~...~..~/' ~.'¢.......~i.,.~ ............ Address/./.¢t~../~¢.~.~./..¢..~ Phone No ..................... Name of Architect 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 Iines. Give street and block number or description' according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COU NT.Y,4DF .........,a....~ ......... dl''~'' · ..~.~.....~...~ ~ ben dui sworn de osesan ........ ,,.' .......,':"_~"t'; ....... ~'": ........... ."'"7'"'~ ................. ' g y , p d soys that he is the applicant ~/' t~ame at ma~waua~ s~gnmg appdca~iom above nv amed. He is the ....... ~ .................................................................................................................. (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 file this application; that all statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application flied therewith Sworn to before me this .......... ....... o, .......... , l/ ' Notary Pu~.~~.aa~.~. Co,nty~]~' ' ............................. E LEV A,TION o F--T- --'T' i I P -FRONT - 5:,," A L E E LEV AT ION-, A5 5O C. i , J it E LEV ATI. Oh,4 ,, : ' !7%0" 7'.0~ ~ ~ ,- A -T P_ 8LO~ : DA ....NOV, LIN, -1 oi 5'- .,~ 4%0 .~.'- lO 8'-I0 CLOS. · REAl? E LB_'v' ATi OM~o oFLIYFtT 51DF_..ELEVAT~O~J~ E L E'v' A i 10h,;,l';'; ,:1