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Home My WebLink About2836-zI~ORM N~O. 4 TOWN OF SOUTHOLD BUILDING DEPAI1TMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~E~T[FI~ATE r~F C~C~.LI~AN~Y THIS CERTIFIES that the building located at .~j.o.n.~..Itq/¢.~ .................. Street Map N~..~.~.~.~d Block No...<~ ...... Lot No ..... J..7.~l ............]~.~t,]'-;i,/;B.~.~,. ~. conforms substantially ~o the Application for Building Permit heretofore filed in this office dated ...... ~.[]cj¢~./¢..9. ......... 19..6.5 pursuant to which Building Permit No. 21~. ~. dated ...... ~o.~U~.t.9 .......... 19.~., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy f. or which this certificate is issued is ....1~ .d.~..~;l,o~. J;0..c412¢.. ~a~£~.~.. d~o3~]. ~.~.~ .................................. The certificate is issued ~o ....3'.o.]?..n. ?.,¢f~i~'o,.q ......................................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......................................... FOI~M NO. 2 TOWN OF $OUTHOLD 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? 2836 Z Permission is hereby granted to: ......... · T~....Za~,~ ........................................ .................. ~t~JJ;lle~ ....................................... to ...]~l..t(~..a~..edc~i. t4_.o~t..o~..~n..~x~s~ng..~tt~.~g. ...................................................... at premises located at ..... ],O.t.,..].7~ ....... ~lapt....aK.tdd..F~t, ......................................................... ....................................... Z, eaa...nead.~ .......... .,.~.~.~];uck,.....l~,.Z, .................................................. pursuant to application dated .................................. &~ .........~ ....... 19.~.~.., and approved by the Building Inspector Fee $...~..,...C~... .......... Building Inspector NAME ADDRESS COMPLAINT REPORT ~O~,,.TV+~t-~ ~T~vozo '~'~, DATE PHONE# HOW RECEIVED, TEL MAIL /" IN PERSON LOCATION OF COMPLAINT NATURE OF COMPLAINT ASSIGNED TO INSP. DATE REMARKS ACTION TAKEN FILE # (IF APPLICABLE) RE-INSP DATE TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............................... , 19 ...... Approved ........................................ , 19..2 ....Permit Na ............................ (Building Inspect~/l~ ..... APPLICATION FOR BUILDING PERMIT Date ............................... Aug.us% ........9...-., 19.6.2 ...... 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 o 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 o~i app icable aws, ordinances, bui ding code and regu arians. J. oh~l..Zaf, eras ..................................................................... (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. ............................................... qw~e.r ...................................................................................................................................... Name of owner of premises ....,I.O}ll~....~rg. ff~/'.e$. ............................................................................................................... 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: ....~a.~t..~ .............. Lot No.: ...1~.~ .............. Street and Number ...... .~a..Ro.a~.~ ........ Na~.ti~uc~ ......................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~e,],l~g ............................................................................................................. b. Intended use and occupancy ...... s~.....t~i.~h...a~..a,?id~ti~R ...................................................................... 3. Nafu~,re of work (check which applicable): New ~Building .................. Addition ....~.~..:~'~.... Alteration ............... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... (to be paid on filing this application) 5, If dwelling, number of dwelling units ......... ~3e ............ Number of dwelling units on each floor ......................... If galrage, number of cars .......................................................................................................................................... 6. If b~siness, 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 a.lterations or additions: Front .................................... Rear ......................... Depth ................................ Height ............................ Number of Stories ................................ 8. DIm~ns,ons of entire new construction: Front ..... ~.6. ........................... Rear ....... .~.6. ................ Depth ].8 Heig'~ht .................... Number of Stories ............... O~e. ........................................................................................... 9. Size jot lot: Front .....%0. .................. Rear ...... %0 .......................... Depth ....~.~'..0. ..................... 10. Date, of Purchase ........................................................ Nome of Former Owner ................................................... 11. Zone or use district in which premises are situated ......... !!~..~!..c~:LS.~ ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~.0 ...................................... No4e of Architect ...................................................... Address ............................................ Phone No ............. &%tZL .~.~,O. ~:. ........... Phone No ................. Na~e of Contractor ...... ~k.~,...~e.~.~...~c..~ ................. Address iv/ - PLOT DIAGRAM Locate clearly and distinctly all bu Idmgs, whether exmhng or proposed, and ad,cate all set-back dimensions fr~ property lines. Give street and block number or description according to deed, and show street names and indict whether interior or corner lot. STATE aFl NEW: YORK. COUNTY OF ..~,,~..~..~.0.~ ............. ,f"'""' ................. i ............... ,,T..P~2,D,..~,~I~f~q .................................... being duty sworn, deposes and says that he is the applic~ '~(Name of individual signing application) above na~ed. He is the ......................0..~.~.~.~. ..................................................................................................................... (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 all statements contained in this application are true to the best of his knowledge and belief; that the w~rk will be performed in the manner set forth in the opplicatio~ filed therewith. Sworn to before me this ................. cj..., day of ..................... · LD D P A . Noto,-y Puj~,,c, ~st~'~... Cou~:~,gnature o,'~ ] No. 52-0618~1'00 Sullol~/O,~!hb,