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Home My WebLink About2942-zFOP~M 1~0. 4 TOWN OF flOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIP. ATE: r'~F D[::mUPANBY No .... .~. ,2..~.9.7.. Date ....... THIS CERTIFIES that the buildlng located at .~O~.~$vm. ............. Street ~em~ Mouthold Map N~U. ~0~... Block No...~ ...... Lot No ..... ~. ~. ~ ..... S~O~, .~...Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... NOVelS. ~.3 ..... 19..65 pursu'ant to whi~ Building Permit No. dated ...... ~V~O~.2~ ..... 19.6~, was issued, and conforms to all of the require- ments ,of the applicable provisi.ons of the law. The ,occupancy ~or which this certificate issued is ....~i~iOn..~o..on~. ~i~. ~e~lin9 .................................. The certificate is issued ~o ... ~. ~...& .~'9~..~l~ ...................... (owner, lessee or tenant) of the aforesaid building. ~Suffolk County Department of Health Approval ......................................... Building Inspec~~ ..... FOI~ NO. ~ Town OF SOUTHOLD BUILDING DEPARTMENT TOWN C~K'S OFmC~ SOUTHOLD, N. Y. BUILDING' PERMIT · (THIS PERMIT. MUST BE KEPT ON THE PR~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2942 Z Permission is~ hereby granted to: ¢~...~.=. ~,. ~.;~,zi.~...~.~ ....... : ...................... ..~.6....~.~o. ~Ls.~. ........... ...:...~ ......... : ............. ~ .... i. ....... ...... i...i ...... to~..~l~...'aa..~{l:l, tJ, m~,.,.ea..a~a..~x~...(l~a~.-....:: ......... , ........................................ at premises located a; .'~'"'~"~..i..~.e.'.~...'~'"~'.~..~...e. ........ i:.._.i...:.... ....................... '....; ......................... ....... ..... ~ ............. i ...... ' ............. 8~taho,'l.~.t,....~.Y.:...,: ........................... ' ........................ , ............................ pursuant to, ~pphcotlon dated ..................... ' ....... ~.0.~.1~1~0~..,..~ .....1~.~ .....,~md approved by the Building InsPedtor' ,' : FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined 19 Approved " 19 ...... :~ Permit No..~..' c~,..~....~.. Disapproved a/c ................ '.:..:q. .................... :':;;':l' ............... :4 .................... ................................. '('~;';i~'~'~"i~;;;;',%'{i ................................. Application No. APPLICATION FOR BUILDING PERMIT Dote ..~...:...~....=~ .............................. , ~.~,~.z-.. 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 port of this applicotion. c. The work covered by this applicotion may not be commenced before issua.nce of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 shell 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant egrees to comply with all applicable laws, ordinances, building code and regulations. ,~ ................ ..U.~..~... ..'.Z., Z'.;'l ~>4_4z.~¢~ , ~' (s noture ~"~'~i~;, or"~'~'g~/iT' :~r~'~TF~'A') ........ (Address of applicant) ~~ ~ State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. If opplicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer)" t. Location of land on which proposed work will be don~..Map No.: ........................................ Lot No.: ..~..~...~.. Street and Number ..... ~...~D~... ~ .............. ..~..~.~..~.*-~,~- .......... M;;;~ ~'~f~'.'f~ ................... 'C ........ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ./.~C..~.~...~...~ b. Intended use and occupancy ...... ..'~....~ ~.~. i..;:: ~.'..~.........~.....~.....'~. ~... i .~/~...~...(~ .~. ......................................... 3. NatUre of work (check which applicable): New Build'lng .................. Addition........./... Alteration Repa~ir .................. Removal .................. Demolitian .................. Other Work (Describe) 4. Estir~ated Cost ......:..~...':~......x~.....~...;....~..,~:. .......................... Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ...~ ............... Number of dwelling unffs on each floor If g6rage, number of cars ......... 6. If ~usiness, commercial or mixed occupancy, specify nature an~nt of each type of use 7. Dim[ensions of existing structures, if any: Front ..~.~.,~C..C~e~.~...~.~..~ ......... Depth Height ~. ............. ~......, Number of Stories Dimensions of same st~cture with alterations or additions: Front ..... .~.~..~..~.. Rear ..~..~., Depth ~.~...~.~..~.~ ....... Height .~.~..~.:.~....~.~Number of Stories ...~ ........... ~.' ............. 8. Dimensions of entire new construction: Front ..t.~.~..~.,.~. ............. Rear ..¢.~.~ .......... Height ~.~Z.'..~Number of Stories ......... ~ ............... 9. Size~ of lot: Front ...(.~.~....~¢.%.~.. Rear ..../.~.~..~.¢,~.~. ....... Depth ..~.~.~...~.¢.%..~.. ]0. Dat~ of Purchase ...... ~.~.¢..'....~.¢./...~..~..~ ......... Name of Former Owner ..,~.¢..~.~.9..¢ ........ ~....~..% 1 1. Zonb or use district in which premises ore situated %¢ o ~ ~ ~ L ~ Does proposed construction violote any zoning Iow, ordinance or requlation~ . 13. Name of Owner of premJsesg. 7...~....(.~....~ ................ Address ....~ ............... (~,.~ ..........Phone No.~..~.%[.~. Name of Architect ...... ~,~.~..~. ................................ Address -- Phone No. Name of Contractor ................................................... Address ............................................ Phone No. ~ PLOT DIAG~M L.ocot$ cleorly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property li,nes. Give street and block number or description according to deed, and show street homes and indic whether interior or corner lot. ............. COUNTY OF '/ ~- ~' ~ ' ' .............. ~ ............. ~.~ ............................................. ~ .......... Demg duly sworn, deposes and says th~ he is the applio (Na~e o~ndividual signing, above na~ed. He is the , (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or haw performed the said work an~ to make and fhJs application; that all stafements contained in this application are true to the best of ~is knowledge and belief; that the work will be performed Jn the manner set ~o~th Jn the filed Sworn tobefore me this ,~ ~Notary Public, '"'Lw~ ....... k~ .......................... ~g~ ...... (Signature of aj MuaJified in Nassau ,erin ~pires March ~. ,.Y