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Home My WebLink About2839-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, ¥. No. I~..e~.~.l .... Date ............... l~:e. el~ ....1,3 .... 19.67 THIS CEi~TIFIES that the building located at .llttl$ .0l.d.P~I'boI'. tt~1 ........ Street Map No... ~ ...... Block No ..... II~I:X .... Lot No. ~ ..... t~I~. ~ll~'fo~Lk-y .N.,¥~. · · conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ....... Aug...9 ........... 19.6~ pursuant to which Building Permit No. ~t~39. Z. dated ........ Allg.....~,0 ....... 19.~>r~., 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 P.~lVago. one. t:a~n&ly..dw$tl.i, lag. ........................................... The certificate is issued 1~o ...141.,I~,]hoclc~oClcl ....... 0!gl~eI~ ........ . .................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ............. ],'95(> · · · ~Y' t~. '~lI.~'a. · 'FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST B~ KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2839 z Permission is hereby granted to: pursuant to application da~ed ................................. A~J~JJ.~J~.~...~, ..... 19..~'., and approved by the Building Inspector $3~0 Fee m ........... Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Exomined ...................................... ]9.. .?. Approved ................................. . ....... , 19 ........ Permit No ................................. Application No. c~3c~'~ ~ APPLICATION FOR BUILDING PER.MIT 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 part 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 shall be occupied or used in whole or in part ~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 o 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. .... ...................... (Signature of applicant, or name, if o corporation) r ........... , ............... ................... ........... (Address c~applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................~..i~.~...~.~..-~... ................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number .~..'.~../~./.~.'.~...~...~..%~...~...~..~~.,..~.'..~......~.:...~...,.-- ,.,-...~ -- ............................................... M,6rficipa IFty State existing use and occupancy of premises and intended use and occupancy of proposed constructi?n: a. Existing use and occupancy ................................ .~.~~ .............................................. ~ ........................... b. Intended use and occupancy ....................................................................................................... 3. NatJ~re of work (check which applicable): New Building ..... ~ ......... Addition .................. Alteration .............. Repgir .................... Removal .................... Demolition .................... Other Work (Describe) .................................. 4. Estimated Cost ............................................................ Fee .. (to be paid on filing this application) 5. If d~elling, number of dwelling units .............. ~ ........... Number of dwelling units on each floor ........................ If g?rage, number of cars ....................................................................................................................................... 6. If' ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................... 7. Dim,ensions 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. Dim, ensions of entire new construction: Front ........ ~.~...~./~ ......... Rear ...~...r:.. ................. Depth ........................ Height ........ ..~..~/...f ........... Number of Stories ~ ,, ~ ~, ........ ; .................. 9. S~ze of lot. Front ....... ~.~.~?. ............ Rear ...... ~ ................ Depth ..~ ............. ~0. Date of Purchase ........................................................ Name o~ ~o~me~ O~.e~ ~"~(~......~... ...................... 11. Zone or use d.str,ct m wh.ch premises ares tuated .............. ~.. ........ ~.~. ....... ~-.~... ....................... 12. Does proposed construction~L~lt=,~j~ any zoning Iow, ordinance or regulation? ............... .¢~. ........................... Norhe of Architect .,~.,..~,',~..~ ................ Address~_ ././~v~-..~..,.~.~., Phoh~' .e~...'.~..~.~ .... No~e of Contractor ~.~..~..'..~ ......... Address (/ ..~:.~..,. Phon~l~o.~...'~...,5~..~...7, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. ~"~'"~-~'~'¢' ~T£~ m STATE oF NEW YORK, COUNTY OF ................................ .......... ~ .."~.....; ......... :~ ................ being duly sworn, deposes and says that he is the appll (Nome of indivldua sign ng oppl cat on) above named. He is the ................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly euthorlzed to perform or hove performed the said work and to make and this appli~otienj that oil statements contained in this application are true to the best of his knowledge end end that the work will be per~ormed in the manner set {orth in the application filed therewith. Sworn to be~tore me this~/~ ,,~ 19 · Il . .ZD..4 ..........day of ....... ~~ .......... , ...... , ,~ _ ~ ,~ .......... ~.~fl ....... ; ............................... g .......................... JL .....