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Home My WebLink About3207-zFOI~I~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD. N. Y. OF' O0011PANOY No .... ~...2,5..9.~.. Date ......... ~,0~$..~? .......... 1~... THIS CERTIFIES that the building located at J~.~ .l~Ct;~d. ~. ~l,t;. D~... Street Map No..~. ....... Block No.. ~ ...... Lot No ......... conforms substantially to the App]icati,on for Building Permit heretofore filed in this office dated ...... $1a[ai;~:. 6. ..... 1966. pursuant to which Building Permit N~0~..2~... dated ...... ~..el~.~..e.~.r..6 ..... , :19,6~., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .o~cupancy f. or which this certificate is issued is ....... ~r~. ~.e.~X[f. ~in~ .......................................... The certificate is issued to ..... [R~O~.& .~1~_~_ .~nti~l ......................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ..................................... .. .... ..... ...... Building Insp FO~.~ 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? 3207 z Permission is hereby granted to: ...:/~e~..~.~ ....................................................... ..... ~.d....~...~.t....~.~ ................................... to ~.d....g.~....~.q.~l~...l~ 1~.! ~ ...... ~.u.. me~r.. ~a.l~L..al~ a ........................................ ot premises locoted ot ~.~..~,.?~1 ~,..~l~t~ ...... {~..~..0....~.p,...~.,,..,D,,....~,.,), ....................................... .................................... ll~n~,.~o ........................................................................................ pursuant to 9pplicotion doted ...................... .~...e.l~.~. ......... ~. ................. 19.~t~..., crud opproved by the Building Inspector FO~M ~0. 1 TOWN OF SOUTHOLD BUILDING DEPART/d, ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .......... ..... ,, ., 320'7 2_ Approved ......................................... 1 9 ........ Permit No ................................. ............................. ................................. Application No ........................... APPLICATION FOR BUILDING PERMIT Date .......... INSTRUCTIONS a. Tbs 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 :Bu~ldmgs on premises, relationship to adlommg 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 this applicatior c. The work covered by this application may not be commenced before ~ssuance of Buildmg Permit. d. Upon approval of th~s application, the Bu~ldmg Inspector w~ll issue a Bu~ldmg Permit to the applicant. Suc permit shall be kept on the premises available for mspect~on throughout the progress of the work. e No buildmg shall be occupied or used in whole or m part For any purpose whatever until a Certificate of Occupanc shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to th Building Zone Ordmance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordmances , Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbe, to ordinances, building code and regulations. The apphcant agrees comply with all apphcable laws, app State whether applicant is owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builde Nome of owner of premises ................ If applicant is a corporote, signature of duly outhorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wiLl, be done. Ma, p No ............................... Street and Number ........................ .....,--..........s.:.~,..,.r~,r~..~,cv....~.f .................................................................. Mumcipality 2 State ex~sting use and occupancy of premises and ~ntended use and occupancy of proposed construction: a Ex,stag use and occupancy b. Intendeduseandoccupancy.~~....~~¢~~-/~ ~.4 .J~A_ ......................... 3. Nature of work (check which applicable) New Budding ................ Addition .................. Alteration ................ Repmr .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Estimated Cost ..J..~. .................................................... Fee ........................................................................................ (to be prod on fihng this application) 5 If dwelhng, number of dwelling units ............................ Number of dwelling units on each floor .......................... If garage, number of cars ......................................................................................................................................... 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .................... ;t ......... 7. D,mens,ons of existing structures, ~f any: Front .... ~.].~..~..! ........... Rear .....~'..~.].( .............. Depth ......,'~,....~... ............ He,ght ..... I.~. ................... Number of Stories ..........J'. ............................... ~..:...? ................ .~...~::~.~...;,.....]]]]]] D~mens~ons of same structure w~th alterations or additions Front ................................................. / Depth ...~......47~.~.!. ...... Height ....].Z ..................... Number of Stories ........ l ............................... 8 D~mensions of entire new construction. Front /. {) ! .................. Rear I iD ! Depth Height ~ r ~ U Number of Stories ~ .... ~'~ 9. S,ze of lot' Front ..... .~...~.~'.. ............. Rear ..~. .................. Depth . 10. Date of Purchase ..........1..~..~..~.~.]']. ............................. Name of Former Owner 11. Zone or use district m whmh premises are s~tuated ............................................................................................... 12. Does proposed construction wolate any zomng law, ordinance or regulation? ..... ~.~. ......................................... 13. Name of Owner of prem,ses .~..c~...?..~....~...bTJ..~...~.. ......... Address~...~..kl~.~.~.~.~...~..qR.~l?.C~..~.. Phone No.~o~..~.~..~. Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor ..~....f ............................................. Address ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fror property hnes G~ve street and block numbers or description according to deed, and show street names and ~nd~cal whether interior or corner lot. STATE OF NE~/V YORI~ ~/7 ~ ~//] q q COUNTY OF ....... .... ,- ,., .... of ind(wdua sigmng' ........ apphcat on) bemg~ame duly sworn, deposes and says that he is the opplica above named. Cie ts the .......................................... ~ ................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f~ this apphcation, that all statements contained in this application are true to the best of his knowledge and beli~ and that the work wdl be performed in the manner set forth ~n the apphcation filed therewith. Sworn to b~fore; me this /,~ . /~ ,-. .............. /~...~.... day of/~ ......... ' 19"~' '~/ ~-~/J,~ ~rT.~, ~/~/~ /j~/'~'~ '/ //'~//~ ' .... ............ Notary Pubhc/..//~ ...... ~....C~.~...~.;.:;.lon ~c~,~,yr /' (S,gnature of applicant) -- (/ NOTARY PUBLIC, Sta'e of i'Jew York No 52 3233120 Suffol]~ Count~' T~rm gxplr¢~ IVl~r~h 80,