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Home My WebLink About2849-zFOBM ~0. 4 TOWN OF SOUT/-/OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. :E:RTIFIGATE: rIF QOP. UI~ANI~Y No. ~..27.~6. .... Date ................... l~y.... ~7.., 19.6~. THIS CERTIFIES that the building located at . .~/.~.~I~lg~8..I~ ........... Street Map No .... Y~:.~ .... Block No.. ~ ........ Lot No.y~... I~.~,~;:].~ll~k-~r -N'.~ ........... conl~orms substantially ~o the Applicati,on for Building Permit heretofore filed in this office dated ........... ~g~8~. 2~.., 19~.~.. pursuant to which Building Permit No. ~.[I.~F,... dated ............... ~t~g.-.~., 19.6~., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy 2or which this certificate is issued is .~$'~Va.~. ~tne..:~al'llil ~ .cll4~i.l~t~ .......................................... The certificate is issued t,o P.~t~.~,..V~gl~.es .&.~4~fe. ......... 0~e:P~ ................. ' (owner, lessee or tenant) of the aforesaid building. .Suffolk County Departme~nt of Health Approval ..... .~.~.R..~ ............................... /Bull(ding Inspector FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2849 Z Permission is hereby granted to: . .~...~..e.~...~ ..~ ...V..~g..n.~. ................................. .......... Ile~,gle~...I~' .............................................. ................. ...~...~..t.~.,......~.:.~.... ....................... to ..... Bu~,&d.. ~ ..a~d&t;~er~ ..ot~ ..~.. ~R ~g...d~ll:Lng ..................................................... at premises located at ..J~....~rrLl~,e~...~. ....................................................................................... ............................................... ~..tt£tuek,.....~.~. ............................................................................. pursuant to application dated ............................... ~,~tl.~;.....~-~[ .....19.6,~..., and approved by the Building Inspector Fee$.~ ............. Building InspeCtor t FOI{,M NO. I Examined ........................................ , 19 ........ Approved.. ....................................... , 19 ........ Permit No ............................. Disapproved a/c .............................................................................................. oo8 (Building Insp~jF~) Application No ............................. APPLICATION FOR BUILDING PERMIT Date .................................. 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 pa=rt of this application. c. The work covereft by this application may not be commenced before issuance of Building Permit. d. Upon approval df 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 prggr~,ss of the work. e. No building shall be occupied or used in whole or in pa[t fbr'8~p,~r-~os~whatever until a Certificate of Occupancy shall have been grante~ by the Building Inspector. APPLICATION IS ILIEREBY MADE to the Building Department r the'~s'~on :e of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk Count'~j~'N&~; ~rk, ~nd other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterat~pns, or for re'navaL or demolition, as herein described. The applicant agrees to ;amply with all applicable laws, ordinancles, building c)de and regulations. ................................................... I (Si~?at.(/rf~of app'lJ]cant, or name, if a corporation) ~..D~' ....... ~$~t .ti.tuck ............................. Address of applicant) State whether applica,~t~is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of/prerhises .Pe~be~../~.l~.~s.,&..!~.l.~'e ..................................................................................................... If applicant is a/!orporate, signature of ~uly authorized officer. (N~'me and title of corporote~o~'cer) 1. LocatiOn ,6f land on which proposed work will be done..Map No.: ............. ZXZ ............. ..~..~..Ok'}b'~.:Y-,,~% ................. Municipality 2. Sta~e ekisting use and occupancy of premises and intended use and oc~5~y of proposed construction: o. ' E~isting use and occupancy ................. ~'O~.~e~G ............................................................................................ 3. Nat~Ire of work (check which applicable): New BuiMing ~ ................. Addition ...... ~ ..... Alteration .............. Repc~ir .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estir~ated Cost .......... .~.0..0...~Z'.~ ................................. Fee .~. ...... ~ ............................................................................ (to be paid on filing this application) 5. If d~veffing, number of dwelling units ............................ Number of dwelling units on each floor ........................ If g?rage, number of cars ......................................................................................................................................... 6. If l~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'h ........................ Number of Stories ............................................................................................... ' ............... Dimensions! of same structure with a,lterations or additions: Front .................................... Rear ........................ Dep{h ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ,l~.~..-..~. ..................... Rear ...... ].~..~.0. ............ Depth ..... .2...~. .......... Hei ht .................... Number of Stories ...... c~e .................................................................................................. 9. Size of lot: Front ............................ Rear ................................... Depth ................................ 10. Dat( of Purchase ........................................................ Name of Former Owner .................................................. 11. Zor ~ or use district in which premises are situated ............ !!,6.!!...d;gs.i;. ................................................................ 12, Doe, proposed construction violate any zoning law, ordinance or regulation? ............ ~ ....................................... 13. Name of Owner of premises ....~L~.~...V.J-8;~,e.,~..~..,.~....Address ...... Zvi~-.iL.t,I.t. lto3~ ................ Phone No ................ Name of Architect .................. ~e .......................... Address ............................................ Phone No ............... Nar6e of Contractor ................... se~me ........................ Address ............................................ Phone No ............... PLOT DIAGRAM Locot~clearly end distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property li~es. Give street and block number or description according to deed and show street names and indic~ whether interior or corner lot. STATE OFi NEW YOR~, / c c COUNTY OF ...... cd.~. ~'.Q 3~ ......... ~ ~"~' ............................. ~/R0,.....~.~kg~q~ ....................................... being duly sworn, deposes and says that he is the applic Name of individual signing application) above nan ed. He is the ................. .o...~..tg..e.~ ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said o~er 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 application filed therewith. Sworn to b?fore me this /x ................ i..2..~ day of .................... A.'~,~t; ......... , 19.~.~... Notary Public, ./.~.,]./~-~-....(-~(..'..,.(..~.~~m~lt~'. R£~[Nr (Signature of appticar ~ [ [ NOTARY PUBLI~, State of New Yor~ I~/ No. 52-3_23~120 SuffoLk Count~' Yerm Expires March 30, 19