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Home My WebLink About3206-zTOWN OF SOUTHOLD BUILDING DEPARTMENT ~'OWN CLERK'S OFFICE SOUTHOLD, N, Y. OE:RTIFII::IATE: QF QP. OLIPANI::Y No..[~. 2~r3... Date ............... 0~t,...18 ..... , 19..66 THIS CERTIFIES that the building located at -t~/1~-..R',l~,,h· P,d .............. Street Map No. ~ ........ Block No ...... ~ .... Lot No. XXX... ~4a.tti.tuck,. N.,Y, ........ conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated .......... Sel~t; - 6 .... 19..(~6 pursuant to which Building Permit No. ~-2O(Y dated .............. ~10t ..(~., 19.6~, was issued, and conforms to all of the require- merits .of the applicable provisions of the law. The occupancy for which this certificate is issued is ...Private. ane. £amily. dwe!lAng .................................... The certificate is issued to .. P, allayill, tis.· Dolll~;l~ioll ......... 01gl~,2 .............. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval .... ~,. R, .................... .......... 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) N9 3206 Date ..................... {}{151])~{~,~1~ ....... ~. ....... , 19.~.... Permission is hereby granted to: .lk~... a{;~l.t~..~....~C.....~...l;~at~iou ................ Yiae:t~nsek .......................................... to ... ,~.. ~u~. ~14~ .~I¢)n.. er,. ,~m..e~e~;~sg.. ~iwe 3.3~ i~ ...................................................... ct premises located at ...~./].....]]~t~, ~0~,~ ...................................................................................... ................................... Mat, t~ttuek~....~.:g. ................................................................................... pursuant to application dated ......................... ~ .............. J~ .........19..~., and approved by the Building Inspector Fee $~{~10, .............. Building Inspector NO. I TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ........................... Approved ~ ~ 19 ........ Permit No Dlsapp roved a/c .............................................................................................. ..................... ......... APPLICATION FOR BUILDING PERMIT Date ................................... ~e~ ...... 6 ..... , 1 ~.(~ .... INSTRUCTIONS a. This appficat~on 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, relationship to adjoining premises or public streets c areas, and gwmg a detailed description of layout of propertymust be drawn on the d~agram which is part of th~s applicatior c The work covered by this apphcation 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. Suc permit shall bl 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 Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding 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 apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to co.reply w~th all apphcable laws, ordinances, building code and regulations. ................................................................ (Signature of apphcant, or name, if a corporation) ~attituek (Address of apphcant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, .................................. ...................................................................................................................................... Name of owner of premiseS; ....... ..~...~ .~....~..~.~.~.....~.~....0~.. ..................................................................................... If applicant is a corporate,~ignature 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' ~ ............ ber ~/S ~uth Roadt Street and Num i ................................................................................................................................................... Mumc~pality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~sting use ~n~xoccupancy . ..~11:J~ ....................................................................................................... b Intended use and .occupancy ............ JJ~I~G..~t~..~..~d:~t'lO~ ............................................................... I 3 Nature of work (check which applicable): New Budding .................. Addition ..... ~ Alteration ................. Repair ................... Removal .................... Demolihon .................... Other Work (Describe) .................................... 4 Estimated Cost ...... .~,jOgO ......................................... Fee ........ ~'~..0..0.. ...................................................................... (to be pa~d on filing this apphcation) 5. If dwelhng, number of dwelhng units .... ~ ................ Number of dwelling units on each floor .......................... If garage, number of cars .......................................................................................................................................... 6 If b'usmess, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7 D~mensions of existing structures, if any: Front .......................... Rear .......................... Depth .......................... Height ........................... Number of Stones ............................................................................................................. D~mens~ons of same structure w~th alterations or add,boris. Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. D~mensions of enhre new construction: Front ....... ~. ................ Rear ........... ~ ............ Depth ........... ~. .......... Height ........................... Number of Stories ............................ 9. S~ze of lot. Front ........................... Rear ........................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 11 Zone or use d,stnct ~n which prem,ses are s,tuated ....... .~..~..~....~..~..~.~. ..................................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulation? .............. ~ ................................ 13. Name of Owner of prem,ses ........ ]~..]lelll~t,~.~.~...Address ..~..J~...~.....3~.t~.....~~ne No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor ....... ]~..,~]~it~.....~ .......... Address ......... ...J~....~..~.~.~.~ ............ Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex,sting or proposed, and ind,cate all set-back dimensions fro~ property hnes G~ve street and block numbers or description according to deed, and show street names and red,cai whether interior or corner lot. STATE OF NEW Y~OR.I~,... ~ S.S COUNTY OF ....... ..~-~.[g~.~ ......... ............................. ~l~Jl~...JJ~::J,::~,~ ........................................... being duly sworn, deposes and says that he ~s the applica (Name of individual signing application) above named. He is the ............. ~:~¢Z'~.~:~ ................................................................................................................ (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 f th~s apphcation, that all statements contained in th~s application are true to the best of h~s knowledge and bell. and that the work w,II be performed in the manner set forth in the application filed therewith. Sworn to before me th~s ................... ~.. day of ................... ,~e~.., 19 ........ Notary Public,~~~~ounty ~'"' (S~gnatu;; of ~i[;~'~" ....................... ~OTARY kb~: ~ ~ '~w York