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Home My WebLink About2776-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P.E:RTIFIP. ATE: OF Or-P-UPANCY THIS CERTIr'I~S that the building located at .~J~l ~ ]~wd ............ Street ~ ....... Block No .... ~ ..... Lot No..~...~(~... ][.Y., ......... conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated ............... ~'. .... ~.~-9. ~ pursuant to which Building Permit No..~m~. ~ dated ................ .¥..~Y..~., 19.~'., was issued, and conforms to all of the require- merits of the .applicable provisions of the law. The .occupancy for which this certificate is issued is .. l~Ira~e..on~, f~y. ~,~?~in.g ......................................... The certificate is issued t,o ~e.~...~l~.~$V..~. 0 ........ '.~ ......................... (owner, lessee or tenant) o~ the aforesaid building. Suffolk County Department of Health Approval .... ]~0~. 10t. 196~..b~..l~¥t1~1~ ....... Building Inspector( FOI~M 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) N? 2776 Z Permission is hereby granted to: ~. ~..e..L..~..~;t.t~.~ ............................................. ............... ~.~..... Abr. w.. ?.~.~ e. ......................... ................... ,.~,,, b~.o..?..k. .............................. to ...~.~....a..e.~..g~.e...£~t3.~r...{L~eZ].La8 .................................................................................... ct premises located at ..... ~.~..~,.~.....~D.(~. ............................................................................. .......................................... ~. ~....,,,r~zu~...~l. aa6 .................................................................................... .......................................................... 15.o~l;b.a28 ~ ....... .~oXo ................................................................. pursuant to application dated ............................. ~ ....... ~ ............. 19~'..., and approved by the Building Inspector Fee $....~...0.!...0~.. ......... Building Inspector '~'~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... , A ra ed ......................... ........... , Application No ............................. APPLICATION FOR BUILDING PERMIT Date ............................. ..~..~.~......~.~. ............... 19...~.~. ...... 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 adioining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port 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 shell 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 Deportment 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, os herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code 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. .................................... ......................................................................................................................... Name of owner of premises .Z)..~,~..~.~,~.~.¥.~,~L ......................................................................................... If a~licant 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 Na.: ...... ~.q~. ............ Lot No.: ....~ ............... Street and Number ~S.. ~e~...~.Qa~.....~.o.u~Q~d ................................ MunJci~Jity 2. State existing use and ~cupancy of premises and intended use and ~cu~ncy of propos~ constructi~: a. Existing use and ~cupancy ....... ~a~g~..~ ................................................................................................. · ~ b. Intended use and ~cupancy ........ ~..[.~...~..~ ........................................................................... 3. Nature of work (check which applicable): New Building :....~Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...~7.~.Of)..~./,,l~ ................................... Fee ...... .~..0. ....................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... QD, fl ............... 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 ........ .~.2 ....................... Rear ............. ..bc~. ......... Depth ...... 2.br~.....bc.O..... Height .................... Number of Stories ...... .o13.e ........................................................................................................ 9. Size of lot: Front ........ iL0.0. ............ Rear .............. 3..0.0. .............. Depth .......... ]..LF.~ ............... 10. Date of Purchase .................. ].9.~.6 ............................ Name of Former Owner ....~.~.d.o...D.~.e.[l,.o.D~.~.t~. ............. 11. Zone or use district in which premises are situated ........... t!~.!!...d£s.~ ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ ........................................... 13. Name of Owner of premises ..Da.~..~t;tZL]L£~aza ...... Address ......... T.~nb~'~o]~ ............... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ............ £~.~e. .............................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether i.nterior or corner lot. STATE OF NEW YORK, ~ c c COUNTY OF ...... ~/~£~alk ........ ~' .... ................................... ~,;LeZk..,~u..~..'/..t.~'.a~. ......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............. ~'t~'...,,...b~£.'L~l,e~ ........................................................................................................ (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 a.nd file this application; that ail statements conta:ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ..., .................. do¥of ......................... ........... , f./1 . /2,4 ,// ,¢/2 ' x. Notary Publc~'~x.~./..~.~ ................ ..L~'..,..~..~..~... County , /~(Signature,ed'applica~') .................... ( // v,^mo~ A. r,~:~T ~ - ~ " ,~' NOTARY PUBLk,. Sta',e 0[ Hew Yor// ~1o. 52-3233120 Sui,~; ..... lerrn Exp rill M.~tiih ~ s-9 SUFFOLK COUNTY DEPAFdItENT OF HEALTH Permit No. TO WHOMIT MAY CONCERN: The sewage disoosal facilities for a structure located at (Give de~d location) have been inspected by this Department and found to be satisfactory. D~str~c~ Engineer Distri'ct E~'g£nee~