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Home My WebLink About2890-zTOWN OF SOUTi~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI-IOLD, l~l, Y. E:E~TIFI{~ATE OF E~OP. UPANO¥ No.. 7..,&1,~3 ~. .... Date ............. ~e .... 6 ......... 1956' THIS CERTIFIES that the building located at .W/~...Gl~l~g~;O. 'I)~ ......... Street Ma~.O~..I~0I'... Block No... ~ ....... Lot No. "~gf .... ~as~;' 'l~riot~f · FI;Y'~ .... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated ........... 0~ ..... ~ ..... 19.~. pursuant to which Building Permit No...2~.0.~. dated ......... 00~; ..... .~ ..... , 19~., 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 .... ~ri~rate' 'on~ 'ramify' ~.~e,].ilug ....................................... The certificate is issued to .~ivlg~;O]ff~.Vill~lgr~l.~,~;~.;~.t.e~.~) ........... of the afore.said building. .Suffolk County Department of Health Approval ...~/ay...~.l~. 'l~'' '~r ']~' "~l~[~' ' ' ' Building Inspec~or~ ' Fo~ ~o. ~ 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) Ne 2890 z Permission is hereby granted to: ............. :...t~,ee~pe~...... ........................... : ....... to .....~.t~.. ~o,~..o~e...~,..~ .. ~vet.:l:t~ ......................................................................... · .,: ....... et premises Iocoted ot .........t~,...i.9.......:,:J~l.~O~'.~t~.: ........ :- ................ ' ................................. ................... ~ ..................... ~/~.....~.t.~'~...~ ......... ~.~ ........ : ............ ....... ..: ............... .. pursuant ~6 applicotion dated ....; .......................... 00.~* ....... ...~'."; ....... 19..j~., Ond approved by the Building Inspector Fee $.. ~ .~.i/.g..O....... .... t ~ Buildlhg Inspe~o~ ', ? SUFFOLK COUNTY DEPAE~MENT OF HEALTH Date Fldg. Permit No. TO WHOM IT MAY CONCEE/: The sewage disposal facilities for a structure located at d~ed location) ..... have been inspected by this Department and found to be satisfactory. District Engineer District Engineer" FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ......................................... 19 ........ Permit No ...................... Application No..,~...::.t/...0. .......... APPLICATION FOR BUILDING PERMIT 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 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 whale or in part for any purposew~h~gtever 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, ordinagfes, building code and regulations. '~;~'~('~'i'~'~/-~"~'~ a~plicant, or ~'r~'a corporation) ~ / (Address o~ap~nt) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. ............... ? ......................................................................................................................... If opplicont is ~ corporate, si~noturo of duly authorized officer. (Nome and title of corporate officer) 1. Locatonof andonwhich r osed work will be don ManNa' "~ , ' /,~1~,,. /~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~ .................................................................................................................. b. Intended use and occupancy 3. Not~bre of work (check which applicable): New Building Addition .................. Alteration Reppir ................... ~,emoval ..~ ................. Demolition .................... Other Work (Describe) .................................. 4. Estimated Cost .............. ~,¢ .......................................... Fee ...................................................................................... (to be paid on filing this application) 5. If veiling, number of dwelling units ........... /. ............... Number of dwelling units on each floor ....................... If ~rage, number of cars ....................................................................................................................................... 6. If usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................... 7. Dir ;nsions of existing structures, if any: Front .......................... Rear .......................... Depth ........................ Hei ht ............................ Number of Stories ........................................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ............................ Depth .............................. Height ............................... Number of Stories ........................................ 8. Dirt ensions of entire new construction: Front ~ ~" Rear ....... /~....~...~. ......... Depth .......~...~...i'. ......... Hei]ht ...... ..-~....~.....~. .......... Number of Stories /OD z OO 9. Siz~ of lot: Front ............................ Rear ....... /. .................. Depth ....... /. ............ ~ ....... 10. Dot. of Purchase ...~..~.~..i...(.~..~.../. .................... Name of Former Owner ...(~.~.~ ...................... 11. Zone or use district in which premises are situated ............................................................................................. 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ......... ~ ................................... 13. Nature of Owner of premises~.2~,~....~:...~/~..Address/Z~'....~...~...;~..~Phone No.7..-../.?..~/.:.~ Narhe of Architect ....... , ............................................. Address ............................................. Phone No. '.~,¢'.~....?.: .... ' ........... Address ...~.~~~.:.. Phone No~....~..'?.../.. Narhe of Contractor .~/!-- PLOT DIAGRAM Locat6 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 JndJ~ whether interior or corner lot. STATE OF,NEW¥OP¢/,~,' / ¢¢ II ......... // ............. ~....f/..:...~'<.~ ......................... being duly sworn, deposes and says that he is the applicdht ~/'(~am~ of individual signin I' arian), above no~ed. He is the .............. ~;.n.~..a.~..~...,~ ................................................................................................. .L. ] (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 this application; that all statements contained in this application are true to the best of his knowledge and bell and that t ~e work will be performed in the manner set forth in the appfication filed therewith. Sworn tokeforemethis //~ ]'"...)__' /~"~ .,//2. ......................... day of ............................................ , 19 ........ . ...... ...............