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Home My WebLink About2830-zFOBM 1~0. 4 TOWN OF SOUTHOLD ~TJILDIIq'G DEPARTM~*--NT 'I"OWI~ CLERIC'S OFFICE SOUTHOLD, ~. ¥. I~£1~TIF'Ir:.AT£ Ol;- OI~I~UPANI~Y No...Z...~.7.~.... Date .................... ~TitI~5:..~.., TI-IlS CE'RT][F~ES that the building located at ~t~.~.. ]~lXq~l~a~. tL~¥~ ....... Street Laugh:tug Map No ............. Block No ....... ~l~... Lot No. ~ .... $OI{~;D,,Q~({.) .N~.Y, ......... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated ............. AIIII...3 ..... 19.65. pursuant to which Building Permit No.28j{0. dated ............. A~I{ ....3''" 19.6~, was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy for which this certificate is issued is P.r:tvat~ .one .£amt~. t~ve~:~Itn, g ........................................... The certificate is issued t,o .. l~l~ltl..O~iiO~ge. Tt~gg~XCC ....... 01~e~ ..................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Appsoval ...~.~R, ................................. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK;$ OFFICE , SOUTHOLD, N. Y. BUILDING PERMIT (THIS PER~!~ MUST BE KEPT ONTHE PREM'IsES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2830 Z' Dote ........ 1- ~ 01' premlsGs IOCOTeCI at ...... ~',.~.. ............................................ ; .................. , ..... ~ ....... ~ ............ Building Inspector pursuont to Opplicotion doted ~t ' ............................ , . ., ,. ......................... , , , , , .... and approved by the FOKM ~0. I TOWN OF SOUTHO~.D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............................., 19 ...... ?. ........................................ ~,~ ,~ ,,~4~)~'~ ~ Approved , 19 ........ Permit No...wc.........~....~. ....... D,sapproved a/c ............~ ..................... ~~ .................. :~-~ (Building Inspectc~r) APPLICATION FOR BUILDING PERMIT Date ......................... ..U.. .................. , ~9....>. .... 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 o deCailed description of layout of property must be drawn on the diagram which is part of thi.s application. c. The work covered by this application may not be commenced before issua.nce 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. ~..r..~ .~'..e..~.~ ....... ~.~..T.. ............ (Signature of applicant, or name, if a corporation) .~.t....rc...~..f.4.~.~..~....~..~.~.D.......~...~.[~.o..~.o (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Name of owner of premises .~....~z...~ .~....C.l ~ "~/~' ~'.~.'.~... ~' If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Locationoflandonwhichproposedworkwillbedone..MapNo.: ..... ~i .................... LotNo:~. ~..~,~. Street and ~umber ...~,J~,. ~. ~..~ z~z...~ ~.~ ~ ~ ~...u..~. ~ 3. ............... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~ ................................................................................................... b ,ntendeduseondoccupancy ......... ~q.~ ~ property Ii whether 3. Nature of work (check which applicable): New Building .................. Addition ............. Alteration ............... Repo,ir .................. 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 ......................... f 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 .......~lr.....~.---- .............. Rear ....... ..~/..~. .................. Depth .,(.~...'].~ ....... Height ........................ Number af Stories .............................................................................................................. Dimensions of same structure with a,lterations or additions: Front .................................... Rear ........................ Dep~]h ................................ Height ............................ Number of Stories ................................ 8. Dimtnsions of entire new construction: Front ...~..../~.. ...................... Rear ...~ ................Depth .../...~... .......... Height .................... Number of Stories ...... ~ ................................................................................ ] ...... 9. Size of lot: Front ...........~...?. ........... Rear ...... ~'.,J....~.. ................. Depth .../..~....~./...../.../..~.. 10. Date~ of Purchase ...................................................... l,~/of For.~n~r O~]~er ................................................... 1 1. Zon~ or use district in which premises are situated .,./'~1~ ................ .~f..~..~. ......................................................... 12. DoesJ proposed construction v~t_e a~n~ning law, ordinance ~r~~.. ................................ 13. Na4e_ of Owner of premises ~...~...~.~i~...~.Address ~ .......................... hone No ................. Na~e~ of Architect ....... ,~' [~J~· .................. ,..~. ..................... Address ii~l~iii~'~.iiii'.i'.i Phone No ................. Na,,,e of Contractor ......L......-.~ ................ Address Phone No ................. PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr ~es. Give street and block number or description according to deed, and show street names and indic erior or corner lot. i t STATE afl NEW YORK, COUNTY ?F ................................ ................. ~ ............................................................................... being duly sworn, deposes and says that he is the applio !(Name of individual signing application) above named. He is the .................................................................................................................................................... : (Contracto.r, 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 appliqation; that all statements conta:Jned in this application are true to the best of his knowledge and belief; that the wbrk will be performed in the manner set forth in the application filed therewith. Sworn to before me this ......... "~'""I ....... day of ..(~.¢4~.¢~.¢~T.... .............. , 19.(J...~. fO ............ ................. .................. Notary Public. ~~ County..~-~-~ ,/~ (Signature of J/l~licant) NpTAR¥ J UBHg, Stgre ~f New Yor~ // / ]No. 52-0618100 Suffolk Coum~ty ~]O~lmsmon Expires March 00. 19~.,