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Home My WebLink About2649-zFOR~ ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EIERTIFIE:ATE ElF QP. CUPANCY No....~...~.~..8.~.. Date ......... ~l'..~.? .......... 19...~.6 THIS CERTIFIES that the building located at . M~t. III. ~[O~][ ................. Street Map No.....~.. ...... Block No.. ~ ...... Lot 1~o.~[~[ ........... I~lI~t;~;~.~.~l~,. ~.o. conforms substantially to the Application for Building Permit heretofc~re flied in this office dated ........... III~[~N:~[. I ..... 19~. pursuant to which Building Permit No..~[~49. Z dated ........... ~ .~. ...... 19.6~., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The occupancy f. or which this certificate is issued is ...... bJll~ !_.~l~Jl~ .]~a~,~.d:[ISg.. {~/~) ................................... The certificate is issued t.o . ~l~t:e~'..~!~a~:i~,. ~1~ ................................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ................................ FORM 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? 2649 Z Date ...................... ~1~'~1~ ...... 1 ................ , 19.~.~. Permission is hereby granted to: · .¥al~te~..~,abt~..~ .................................... .......... I~ t.t,i.t, ue~¥...It'.,.t*., .................................. to ..)love.. ~n.. e~t. ~.tln~,. ~bwelae~.s..~i-tdirig..-to.. new..toe a~cic~a .................................. ' at premises locoted at .~P~..~[~-t~li..~O~g[ ........................................................................................ ............................................ lia.~tl-~ueie....,i ..... ]~.~.!l~ ....................................................................... pursuont to applicotion doted ............................... .~r--~ ....... 1 .........19..~., and approved by the Budding Inspector Fee $..;LO,/0(~ ......... Building Inspector/ 1~'~ ~0. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. D~sapp roved a/c .................................. (Building nsp ct ) ^pp cotion No. .......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin. Inspector. b. Plot plan showing location of lot and of buildings on premises, relahonship to adjoining premises or public streets o areas, and giving a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatior 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. SucJ permit shall be kept on the premises available for inspection throughout the progress of the work. e No building shah be occupied or used in whole or in port ~or any purpose whatever until o Certificate of Occuponc' 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 th- Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alteratmns, or for removal or demolition, as herein described The applicant agrees to comply with all apphcable laws, ordmances, building code and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder owner or ~.1~ Name of owner of premises ..W~:bte~....Ga,.a~i~...Z~c ........................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer} 1. Location of land on which proposed work will be done Map No ................... ~.~ ............... Lot No:~.~ .......... ~ · Street and Number ..~..]~..~.~ ..... ~.~%~...~ ............................................................................... Munic~pahty 2. State ex~sting use and occupancy of premises and mtended use and ~cupancy of proposed construction: a. Existing use and ~cupancy ........ ~.~g.~..~ ............................................................................................... b. Intended use and occapancy ..... ~.~.~g.~.~..~P~..~.~P~2g~ .................... 3. Nature of work (check which applicable). New Budding .................. Addition ................. Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..~o.~z~..b3.cl~....~o..~, location 4. Estimated Cost ...... ..b.~).O.,...~,/',,jv~ .................................. Fee ...~.~. ................................................................................ (to be paid on filing this application) 5. If dwelhng, number of dwelling units ............................ Number of dwelling umts on each floor .......................... If garage, number of cars ......................................................................................................................................... 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use ...b.usd,ne~s~ ........ 7. Dimensions of existing structures, if any: Front ........ '1~. ............. Rear ......... 3,8 ............ Depth ....~.~ ................. Height ............................ Number of Stories ....... or~ ............................................................................................... D,mensions of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth .......................... Height ............................ Number of Stories ............................ 9. Size of lot: Front ...... .5.0. ................ Rear ....... .kD. ............... Depth ........ 2.1~0 ................. 10. Date of Purchase .............. 3,.9~)~ ................................ Name of Former Owner ..... J.O.~..]~.C~lZ¢~te~. ................... 11. Zone or use d~stnct in which premises are situated ....... !!~]!...~.~.:S.t. ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;' ............ ~o .................................. 13. Name of Owner of premises .~[&l.t.e:E...br.~hJ.e....T~ddress ....... 3/~,t,~;.i,t,z;,c~ ............... Phone No .................. Name of Architect ...................................................... Address ............................................ Phone No .................. Name of Contractor ........ s_n.;~e. .................................. Address ............................................ Phone No .................. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property lines. Gwe street and black numbers or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NEW YORK, ~ COUNTY OF ..cd.~.t'.o.'t~; ............. I S.S. ...................... .~n,l.t;.~z'...Gr.a]:d.e ........................................... being duly sworn, deposes and says that he is the applio (Name of ind,vidual s,gning apphcation) above named. He is the ...... .P...r..~.$.$~.6~ELt..D~...C. or.D ..................................................................................................... (Contractor, agent, corporate officer, etc.) of sa,d owner or owners, and is duly authorized to perform or have performed the sa,d work and to make and th,s applicat,on; that all statements contained in this application are true to the best of his knowledge and beh and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me th,s ...... ~ .... day of ............... .~.~r.~ ................ , 19..'--(z~r ~ r-'r ,.,--- ~ ~ / ' /". ~' .~--- t, Jn'r.~v Irtl~3U~r~"~qf~''''~''''~ .................................... Notary Fublic, .~'../.~....~.:...~..~...:'.~"i~t~j0 Suliolk 0~n.ty (Signature of applicant) ~' Term Expires March 30, ~