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Home My WebLink About2868-z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. IZIERTIFI~.AT£ I~F IZIGCUPANI~¥ No. Z..~[~ .... Date ............... (~; ..... .~ ..... , 19.6/~. THIS CERTIFIES that the building located at ~/iB.--P~e. ~l(~afi ............ Street Map No.~[~l~ ....... Block No ..... ~.11~' · · Lot No. ~... S,C~O~' ~'~ ......... conforms substan'dally to the Applicati. on for Building Permit heretof<~re filed in this office 868 dated ............ {~e]~ .... ~., 19~.. pu.rsuant to which Building Permit No. '~ll~ dated ............. ~elo'~-' ~=~', 196'~" was issued, and 'donforms to all of the require- ments .of the applicable provisions of the law. The .o.ccupancy ~or ~vhich this certificate is issued is .PZ';~Va~ · Orig. ;~.&~,~.~..(l~/~)[{~.~.~g ........................................... The certificate is issued t,o t~a~IVh .&..~.'~].~.~a;be~;tl .~le.~h .... ;' · ': Ol~cl~l'IB' ............. ' towner, ~essee or ~enant) of the aforesaid building. .Suffolk County Department of Health App.r. oval ...... ~, · · .1~, ........................... FOI~M NO. ~ 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? 2868 z Permission is hereby granted to: ~.~.,~.. ~..z...t.~.~...a.,~ .......................... Southold to ..... ~.~.~.d.~`~.~.d.~.~.~.t..°.~m~o.m~..x..~.~.~.~..°~.°..~.~.~...~. ..................................................... at premises located at ....... ?..]....rt..e....p,..d. ............ .(~.~..I[I~I,~D,~] ..................................................................... ....................................................... ~.~.u.i;l~ol.~ ~ ..... Il, Z, ...................................................................... pursuant to application dated ............................... .~..~.~......~...]: ........... 19....~.~.., and approved by the Building Inspector Fee $...~(X). ........... Building Inspector I~RM NO. 1 Approved ........................................ , I9 ........ Permlt ~o ........... Disapproved a/c~' Application No ............................. APPLICATION FOR BUILDING PERMIT I NSTP, UCTIONS 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 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 wilJ 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 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, bJ4ilding code and regulations. (Signature of apl~cant, or nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ................................................................................................................................ Nome of owner of premises .................................................................................................................................................. If applicant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work wilt be done. Map ~Uo'~''-~7~/'~ -~--Z. ZxE~' /~-/~;~'/~' ~ ............................................... Lot No: .................... Stre~ and Number ~/~ ~0~ ~J~ Municipali~ Stare'existing use and occupancy of premises and intended use and ~cupancy of pr~osed const~ction: a. Existing use and ~cupancy ........ ~~.~ ............................................................................................. b. Intended use and occupancy ................................................................................................................................. 3i Nature of work (check which applicable): New Building .................. Addition / Alteration~ ~ Repair .................... Removal .................... Demolition .................... Other Work (Describe) ................... }~ .................. 4. Estimated Cost .4.~?~'O ......................................... Fee (to be paid on filing this application)7 5. If dwelling, number of dwelling units ........ .O..../~..~ ......... Number of dwelling units on each floor ..... ~ZL/~: ............. If garage, number of cars ................. ..o..../~_~ .............................................................................................................. &. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ....... .-.~.~...~.~.~. ....... Reor ....~..~.../.Z./;. ......... Depth ...~...~...~..;~. ............ Height ............................ Number of Stories ~::~/~'~' Dimensions of same structure with alterations or additions: Front ~'~'" Rear Depth ....... ,..~...~.~..*, ........... Height .............................. Number of Stories ...... ..~...~....~=.~. ...................... 8. Dimensions of entire new construction: Front ....... .~..,.~../..o..:. ........ Rear ,../.~.~..~; ............ Depth Height ............................ Number of Stories .... ..~..'~...~,. ............. 9. Size of lot: Front ..... ../.~.~.!....~.. ....... Rear ...../.~...,~.'...4l'.~. ........ Depth ....../...Z...~.....O.. .............. 10. Date of Purchase ...... ./.~..,~..~.. ..................................... Name of Former Owner .....t~...~..~....~'.......~../~....,~...~..~ ........... 11. Zone or use district in which premises are situated ............ J~...~./..~.~..~..~...~...~.. ................................................. 12. Does proposed construction violate any zoning law, ordinance or re ulation;~ Name of Owner of premises ./~...~.~..~..~...~..~..~..~../~...¢...~..~..~?/~ddress ....~../..~/~....~.47.4~.. ................... Phone No.~..'...~'..T....~..7.~... 13. Name of Architect ....~..~..,~..?..~......~.~....C...~...~'..../~.. ............... Address .....P/..,~'...~.~....~..~...4~...... ................ Phone No.~....~..7.~... Name of Contractor .~.~..~_.~,....~:....~.'..~'...c..../~.. .............. Address .....~'./..4~,,~.....A~..o..~...~. .................. Phone No.--~.....d~..'~...~f'..Z.~., PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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. /7//:}/~.t~' C.~¢Zz%~J/'/.4 Al STATE OF NEW YORK, ~ S.S. COUNTY OF ................................ ........................................................................................... :...~.being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the agRlication filed therewith. Sworn to before me this · .. 19 ........... ....... day of ........ Notary Pub~~.....~..;.....~....c~...~County'"'~;*~','~, ^. ............................. Term Expires March 30, tg..~