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Home My WebLink About2867-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. ERTIFII~ATE OF O00UF~ANOY No. Z. ~.l~'a.1. .... Date .............. ,May .... 31 ......... 19'66 THIS CERTIFIES that the building located at t!}/~.. 'P&~'ait'}se..P~).i. lli;..R(pladStreet Map No...XX, ....... Block No.. ~ ........ Lot No....X%~ · ·. 8~u.~h~.l.d)..N~'Y'~ ....... coniorms substantially ~o the Applicati,on for Building Permit heretofore filed in this office dated .......... Se.p% .... a.~....., 19.65 pm'suant to which Building Permit No. '~86~" ~ dated .............. ~ept$.. '~]., 196~', 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-~'t.%ta.%e. O~.le' '~a~:ty' 'd%ve!lilag' '&- ~ar~:ge' :bnttdirig ................... The certificate is issued t.o ...Reber.~ .L....S.~ot'l~ (owner, ~esnse~e or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ...... N,'R', .............................. Inspector FOP~M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2867 z Date ............................... Permission is hereby granted to: ............ 8o~1~t~ ................................................ to ... '~Ui't& ..an.. ad~.i tion ..mad..'~..a.}te~a~ion~...on..an.-e~i-stir~..g~e~e..&.. .... &pt ..bui.l.d.i-n~ ................................................................................................................................. at premises located at .........R/$.....Pe~ve&i. se..P~..Rea6 .................................................................. ....................................................... Ig~lshet~.....l¢,.¥., ....................................................................... pursuant to application dated ............................... =~p~ ........ 2]. ......... 19..~., and approved by the Building Inspector Fee $'"--~'~..00 ......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............. ~....~...L.., 19..~.~] Approved ........................................ , 19 ........ Permit No .............................. Disapproved a/c ....... ~ ~~.~-- ~ u~ mg nspec or; App',co,on ........... APPLICATION FOR BUILDING PERMIT Date~~....~]../. ....................... , 19.(?.'.t....-~ 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 this applica- tion. 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 appliccnt. 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances qnd regulations. /,~ ~ .__ (Address of al~plicant)/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................... .......................................................................................................... Name of owner of premises .....~.~~.~z....:...;;:~ ................................................................................ If applicant is a ~.m'porate, s igna.ture~'~ d~u~orized officer. I. Location of land on which~roposed work will be done. Map No.: ........................................ Lot No.: ...................... St reet and Number .~'~ ~. ~..~.¢r ~ .~...] ......~..~.....~ .~... ~ ...~....~.. ..................... Municipality'/ '" 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. o. [xisting use end occuponc¥ ...... ~ ............ ..~;:. ....................................................................... b. Intended use end occuponcy ......... :; ..... ~ ...................................................................... 3. Nature of work (check which applicable): New Building .................... Addition ...~'.. Alteration .................. Repair .................. Remova! ......... ~9,:~'"' Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ........./..4P~...~....~....~......c/~..i .......................... Fee ......'~...'~..~: .................................................................... ..o~...~..~.~.. t~ (to be paid on filing this application) 5. If dwelling, number of dwelling un ts ..............~ .............. Number of dwelling units on each floor ............................ If garage, number of cars ....... :~.:..G.~.:£.'~: .................................................................................................................... 6. If business, commercial or mixed occupa,ncy, specify nature and extent of each type of use .................................... 7. Dimensions of existing structures, if any: Front ...... .~..6~ .............. Rear ..... ~..O.. ............... Depth ....~..~ ................... Height ....~ ............... Number of Stories .......~ .... Dimensions of same structure with alterations or additions: Front ....... ~....O. ................ Rear .~..~ ........................ Depth ....d~...4~'. ................... Height ..... ~ ................... Number of Stories .......~... ...................... 8. Dimensions of entire new construction: Front .............................. Rear ....... ~....G. ................ Depth ..../..~... ................... Height ....... ...~..? ................. Number of Stories ..~.~z:... ..................... 9. Size of lot: Front ...~.~.....'~.. ......... Rear .................................. Depth .:.~...'..Q.°.G....-~.. ............ 10. Date of Purchase .......................................................... Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ..... ~..¢:~.~....]~.r3..4¢~..~.~...4...Z7.. .......................................................... 12. Does proposed construct!on violate a. ny zoning !aw, ordinance or regulation? .~/..~ ..................................................... 13. Name of Owner of premises ' .~..: ,~...~ ..... Address ....,~.~Z~~... ........... Phone No ................. Name of Architect ............................. ~ .................. Address ............................................ Phone No ................... Name of Contracto~..'~:~.~..:~.~."~; ........ Addres~~] .................. Phone No .................. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. ~TA~E OF NEW YORK, ) OU TY OF ..................... .................. .:. .......... being duly sworn, d~poses nnd soys thor he is the applicont (Nome or inaiviauat Signing application/ above named. He is the .......................................................................................................................................... (Contractor, agent, corporate officer, etc.) ....... of said awner or owners, and is duly authorized to perform or have p~rf0rmed the said work and to make and file this application; that all statements contained in this application are'true to the best of his knowledge a:nd belief; and that the work will be performed in the manner set fortFi in the application filed therewith. Sworn to before me this ......... ....... day of · ................... ......... Notary Public ..~.~ s~n'~ i~-~,.~t.v,r~r ~ ~ _, '"~'"'7/"TT'"'7'~';;::'"Q ...... ', ....... ; ...................................... · . .---..~.~, ........ ~.,~,.~,.~,..., .~uumy /czx-c~/J,/~ /?~'. t~gnarure at applicant) · No. 52-0618100 Sb~lolk County// -- ' / ~/~(.--- - Commission Expires March 30r 19/~.'~