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Home My WebLink About2825-zFORM NO. 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE nF OP.P. UPANI3Y No. Z. 2¢.~. ...... Date ............. 0e~¢]~el'. ~9..., 19.6~. THIS CERTIFIES that the building located at . ~eeeh. ~ .~elt ~ ~a~ ..... Street Map No:~' ........ Block No...~ ...... Lo~ No. ~ .... ~e~p~e. ~*~.~ ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ~'~. 28, 19 pursuant to ~n of ~o~thold ................ 6.¢ which Building Per, it No. dated ......... ~l~.y ....28.., 19.6.¢, was issued, and conforms to ~ require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~ivaie · o~ .i'ar;~lly. ~¢e:~.].~.. .................................... The certificate is issued to .~l/~q~. ~i~].[~l ....... ~(:~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~li~ Building Inspector 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? 2825 z Permission is hereby granted to: · · .A~ten. · .l~J. et~el.t~.. ........................................ ............ ~z,eea~eoz,.~ ~ ....... .Nv.~ .......................... to ..... ~.34t.....~m~ ..o~e.. ~,aa~.:LT · d~m:~.Z~~. ............................................................................... at premises located at ..... ~:.e~..~&..&..~-..Road ....................................................................... ..................................................... G~e~l:~rt.t ........ ~,'~', .................................................................... pursuant to application dated ............................. ~l~y ....... .~3~ .......... 19..~, and approved by the Building Inspector Fee $.1.0.e-0~ ........... FO~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. [xamined .............. 19.. ..4. Approved ..................................... 1 19 ........ Permit No.. ...... '~.......... ~ ~ ....... ~'~-.... ............................................ ............................... ....................... /"~"'"'~'Building ,nsp~c'~'o'~i ................................. Application No. ~ ~- ~-- APPLICATION FOR BUILDING PERMIT Dote .......................... 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 thi~ 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, building code and regulations. ... An.t.~n ..~&~ n~.e].li ....................................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ........................................ a~ne~....-....buJ, l~.e~. ................................................................................................................... Name of owner of premises ..... .~,~.~..~c~z:.e~7~ .......................................................................................................... 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.: ....~f~ ............... Street and Number ~.~..~...~[~f~fk~ ........ GZ'.9,.e~.C~.~. ................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~fk¢.ft~_.~f~¢~ .................................................................................................. b. Intended use and occupancy ....... ¢~f~-J~ti~.~-.~.e]~i~ ............................................................................ 3. NatUre of work (check which applicable): New Building ..... ...X~.....x~..... Addition .................. Alteration RepAir .................. Removal .................. Demolition .................. Other Work (Describe) (to be paid on filing this application) 5. If al,welling, number of dwelling units ........ orte ............. Number of dwelling units on each floor If go'rage, number of cars 6. If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, Jf 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 ........ 26 ....................... Rear ......... .2..~ ............... Depth ..... 3..2. ...... Height .................... Number of Stories ....one... 9. Sizejof lot: Front ...120...P./.~ ........ Rear ...... .~.0...P./.~ ............... Depth ../,02. ...................... 10. Dat~~ of Purchase ............. 19.~.0 ................................. Name of Former Owner 11. Zon~ or use district in which premises are situated .............. J%.....dJ.S.~ ......... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... DO. ....... Nar~e of Architect ...................................................... Address ............................................ Phone No. Nan~e of Contractor .............. s~, ............................ Address ............................................ Phone No. I PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ~ndicate oil set-back dimensions property iihes. Give street and block number or description according to deed, and show street names and whether interior or corner lot. STATE OF NEW YORK, COUNTY ~OF ........ ~£~1~ ...... ~' .... ................. ' ....... A~J~.c~rt...I!?ic, uz,.el.ll .................................... being duly sworn, deposes and says that he is the i(Name of individua signing opp ication) above na~ed. He is the ....................o.~nal%...-....hlLtlc].ez: ...................................... (Contractor, agent, corporate officer, etc.) 6f said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements conta:ined in this application are true to the best of his knowledge and belief; that the wgrk will be performed in the manner set forth in the application filed therewith. Sworr. to b~fore me this ................ 12-8.. day of ................... ~ ......... J. Ul.y. .... 19..,~.~' No,ar, ul,,c (Signature °f applicant)/ No. 52 0618100 Suffolk Count.v ] Cmmmssmn Expires Marcll 30, 19~.