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Home My WebLink About2789-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EIEF~TIFIE:ATE: OF OP.P. UPANP. Y THIS CERTIFIES that the building located at ...'d/t~ St].~,w&t~ .&~ - - - Street Map ............. ,ot conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... ~.~0.. dated ............. Julia ·. · 3.0, 19 ~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .Pl'lv.a~;e. ol~e. £al~l}'..~t,~tng ...................................... The certificate is issued to . ~ma.t~. ~,l~I/a~ ........ ~A~l: ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... ,~l~4r...J~. ~,~[~ ............. Building InspectorI FORM 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 FULt, COMPLETION OF THE WORK AUTHORIZED) N? 2789 z Permission is hereby granted to: ................. C~toh~e ......................................... to .. Bu~ld..ne~..one.. ,~mn~L3,;~.. d~el3~n~ .................................................................................... at premises located at ....,~Ot, S..)~.,~.~.....),~l,I......)~.~[~. ......... ~,~eJ~8.1:ld.....s~O..~. ............................... ............................................ S t,~ ;L3,w~t e~... A~re, ......... Cutoho~ue .................................................. pursuant to application dated ................................. ~tl~el.....~ .......... 19~,~..., and approved by the Building Inspector Fee $..~..0..?...0~... ........... / Building Inspector\ FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. pp ov d ........................................ 19 ........ Permit No .......... APPLICATION FORBUILDING PERMIT Date.. ........................ ' .... 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuonca of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances an.d. regulations. ~Signature of applicant, or name, if a corporation) -- (Add~lss of applicantY State whether applicant is owner, essee, sent rchitect, engineer, general controctor, electrician, plumber or builder ~a~, ::o:;:: toO;aPr r;or~ ::!. ':i' '~~'~' '~ ............................... ; ............................................. (Name and title of corporate officer) which proposed work will be done. MaD No: ~t1..:~:.l~..-.,~-."....'~... Lot No: .~.~:...~'..~..:.~'..$'"- 1. Location of land on ' ''~i~' ~' ' '~' Street and Number ...~ ...... ~'""~;nicipal,,y - "[' ....... ~ ............................................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy......~7~.'....~ ............................................................................................. b. Intended use and occupancy.......~......~..~...~~n .................................. 3. Nature of work (check which applicable): New Building .............. Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............/...~../...~ ........................... Fee .......... ./..~..:..~ ............................................................. (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 ....................................................................................... .... 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,,,,,~ ~°f same structure with alterations ~or additions: Front ......... ~~ ........... Rear ....~ .............. Depth ...... .,~i~l~..' ............. Height ........... ~ ............ Number of Stories ...... 8. Dimensions of entire new construction: Front ....... /,~....~.... ....... Rear .... ~...~ ........... Depth .~..~ ....... ' ............... Height ..... .~:~.......~.' ........... Number of Stories ......~...~ ........... 9. Size of lot: Front ..... ~..~...2...I. ...... Rear ..~2..i~../.~...~....~... Depth~f~..~..~..c~..~ 10. Date of Purchase ..... -J..~....~...~.. ................................. Name of Former Owner ......~...t...D.~ ............ 1 1. Zone or use district in which premises are situated ........ ~._o~Z...~.....~.....(~,~.:. 12. Does proposed construction violate any zoning, law, ordinance or regulation? ....... ~ ...................................... Name of Owner of prem ses..J~.~, ...~..' ' . ......... Address ~.: . ..~..~....~......J?.' ' Phone NO Name of Architect ........................................................ Address ......................................... Phone NO ..................... Name of Contractor..~.~t/,r~...: ........... Address ..~~.~:f~Phone NO. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) S S. COUNTY[~ D ~ /f~ II [,OF~ ............... ~...t~..) (~J-ame of individual signing application) above named. 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 are true tg~the best of his knowledge and belief; and that the work will be performed in the manner set forth in the ap~licat/fon, filed the~qTewi~l~. Sworn to before me this ./..~:~7~.. day of .~..~ ~ 19 ~' '~'~o ','~,0~,~u~re~' "of app cant, ' .......................................... ~, es Hatch 30L.~'~'~