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Home My WebLink About2792-zFO~ ~0. 4 TOWN OF SOUT~IOLD BUILDING DEPARTMENT 'I'OV~'N CLERK'S OFFICE SOUTHOLD, N. Y. No..~.. ~.~..~. .... Date ................. ~.%~1~.~. ~,~ .... 19..~.~ THIS CERTIFIES that the building located at .~/~ .~.~S~.V.~o~ .DY. .......... Street ~ap No..r~X ........B~ock No...Z,X ....... Lot ~o. XX .... I~ait!t~l~k~..~,7..~ ......... conforms substantially to the Applicati~on for Building Permit heretof, o~e filed in this office dated ............. ~lO.~.'.i.]....2.0.., 19.6.~.. pursuant to which Building Permit No..2~.9.¢..g.. dated ........... ,]:11~-.ti+ .... 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 . ?.~iTate..one · faraiZy, d~w~&ing .......................................... The certificate is issued to . .ItO]~Ol~.t;.& .AI1F~..G%I~I~I'iLOliO ........ O~II2.ors, .......... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health App~r, oval .... ~I.~. ............................... Building Inspector(j~ FOI~M NO. 2 TOWN OF souTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD~ N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2792 Z Permission is hereby granted to: .......~,..:~.~ · ....~: ...... ;~e~.iew..~ve ...... ~ ...................... ;.. ,,..:~,/. ............ :.l~t~a'~ ................................ :... to ..]~,3.d.. ~...a~.!.~.ien..~m~ ..a~.~ex~t~i.~..<l~.~..~ ............................................. ~:: ..... at premises located at J.....~J/.~..,.~-I~W:,I)I~'~Vi~ ....... ~ .......................................... : ................ : ..... · ..~ .................................................... ~l~l~.....I~,.~., ..................................... ; .................... : ............ ...................... ~ ............................... ~ .............................. :: ....... ..~ ........................ : ................ ~ ....... : ............... pursuant to application dated ................................. A.~'j~L~r....4~O ...... ]9..6~.¢ and approved by the Building Inspector~ ~ Iki/ippealls Fee $.~.,.(X) .............. Building ,Inspector FOI~M ~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. c a, 7. ....... E×omined ........ ......................... Approved ....~...S...~......'., 19.~2::':Permif No.....~....~.....~...~.~T.. ......... D,sopproved o/c ..................... .... ....... ...... ................................. (Buildin~rinspector) Application No. ''~ 7 ¢~ L~ APPLICATION FOR BUILDING PERMIT p~ r~ p_ i ~_ ~o ~...~.~. Date ............................................................ , INSTRUCTIONS o. 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 propertymust 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. Nb building shall be occupied or used in whole or in port ~or 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 Lows, 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 all applicable laws, ordinances, building code and regulations. .... · · .~. · .(~.~.~.; .e ~f · .~ .1~ .~~,'(~ '~; '1~ '~; 'c~.?c~i · -. ....... (Address of applicant) State whether applicant' is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. . , c?..~./E ~ ................................................................................................................................................. Name of owner of premises ......... ~.~.;..~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 ......... .~..~.~ ......... ~).~.~ ........ ~.~.[.~.~ ...................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ~.C.(/.~.~. ........... ~.~.~..~.~ ................................................................ b. Intended use and occupancy ........... .~.~,~.,~. .......................................................... ~ ................... ~ ................... 3. Natgre of work (check which appl lc): New Building .................. Additi ........... Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) 4. Estimated Cost ............... ..~....?...O...O..:..~.e ......................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........ If g,~rage, number of cars 6. If b~usiness, commercial or mixed occupancy, specify nature and extent of each type of use .. 7. D'mbnsions of existing structures, if any: Front ....... ..5~...~../. ........... Rear ....... .~...~. ............. Depth Height ........ ./(~../ ............. Number of Stories ............/. Dimensions of same structure with alterations or additions: Front ............ ~.~../. ........... Rear ........ .~...~.. ' Depth .......~...~.~. ............... Height ......... t(.~.~ ............. Number of Stories .........../.i .......................... 0~ ............................ 8. Dim~ensions of entire new construction: Front ......... .~. ................ Rear '-~O/ Depth .........~ ............. Height ........ ~.~...f ............. Number of Stories ............./. .............. 9. Size; of lot: Front ..~1¢.r...~./'.. ......... Rear ..... .~.:..0..~ .......... Depth ..~..~...O..;..O-?.......~..../..~.9/' ~ '? 10. Date of Purchase ..../k'.O.//~.ff2~/.;~ ....... /~../../..?.~..~.'...Name of Former Owner ......... ~:..O..(.)...~'..~...~... 11. Zone or use district in which premises are s~tuated ........... Z~..~-...~.~..(~-~..~.. ........................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ 13. Name of Owner of premises ...~...~....~../¢.~.4~ .......... Address ~,J£~? ///~uJ /~././/~ Phone No. Na*e of Architect ~.9.¢/¢¢/?..~........~..F.'~.~.4.~....c~g... .......... Address .~..-4~.K.....W.¢..~.....Dzgl~i¢, ...... Phone No. Na~e of Contractor .t~e. tb¢.~ .2Z'......~R.'?...~...~./.~.~.~......Address .~;~..~T...'v.~'f'''~-'.J)(f':~t'~'''' Phone No.~ PLOT DIAGRAM Locat'e clearly end distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions property lipes. Give street and block numbers or description according to deed, and show street names and whether interior or corner lot. Sworn to]~efgre me this j~ ~ ~-- ,'?~ . J ~ .......................... , ~:,~ ........ /"~'~"~ ......... ;x~ ....... '. k~t~p~W]C~ ~.~.~.~ ....... .~ . County [~ignature at ~yA~zPO~/~tat~.u~.N~yo~,.~ ..,~.....:fl ..... :...~,.~ ....... ~alifled In NassoU ~tyl. ~' ~ / ~ - 40/= /" applicant) STAT~ OF NEW YOR~K, } COUNTY OF ...,$..~.~..-E.9..L.:!.c.. ....... ~ S.S. ~0~ ~ ................................................ o duly sworn, deposes and soys that he is the appli, ...... '~'g~; of individual signing applicat o.) above na~ed. He is the ........ ¢.~'.~J (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 this application that ail statements contained in this application are true to the best of his knowledge and be and that the work wi be performed in the manner set forth in the application filed therewith.