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Home My WebLink About3209-zFORi~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPABTMENT TOWN CLERK'S OFFIC~- SOUTHOLD. N. Y. O£RTIFIOATE OF' O00UPANOY No...$..~.5. ?.~... Date ......... ~,~l:~;r. 2.~. ......... 19...$6 THIS CERTIFIES that the building located at . .~.O.'q.U.c], .~.~.~.1~.~. .............. Street Map No... ~ ..... Block No...~ ...... Lot No...~ ....... l~t~;[~:~k,..~o.~o conforms substantially to the Applicati. on for Building Permit heretofore filed in this office dated ......... ~;~I~ .~.., 19~6. pursuant to which Building Permit No. ~2-09-~- dated ......... $~.~;~'..6.., 19.t,6, was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The occupancy f. or which this certificate is issued is ..... .~.~.~..~.t.~.9.~...~.~..9.~.~.. ~.~li~;l.~y..~l~ill~ ................................. The certificate is issued to ...... .D~..~,9.~..y' I~..~lJ.a.~..l~..~. ................................. (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Appr. ova] ........................................ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3209 z Date ......................... ~tJ~talJlJ~.....6 .... , 19(~... Permission is hereby granted to: ........ · ~a~l~Ae~,....N~.Y~ ................................. to .~..~.. ~o~" ~ia--~..ext~t;L~.-.awX:t~x~g ......................................................... ct premises located at ...~..,...~-~,.A'211I .................................................................................... .............................................. I~a$.t~ak~.... ~i~.~ ~ ............................................................................ pursuant to application dated ............................. J]JJtJ:l~e ....... .~ ..........194~.., and approved by the Building Inspector Fee $.y. O0 ............. Building Inspector NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examine ........ ~......~o...., 1 ^pp oved .................................. Permit APPLICATION FOR BUILDING PERMIT Date .....~...~...p..~...~....~...~....~....~. ...... ~ ...... 19. ~., ~. INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted tn duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets · areas, and giving a detailed description of layout of property must 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 apphcant Such perm shall be 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 Building Department for the ~ssuance of a Building Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances , Regulahons, for the construction of buildings, addmons or alterations, or for removal or demolmon, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code and regulations - / . ................................ (S~gnature of applicant,,~ name, if a corporation) ........... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises ............. ~v,= .~... ................ r If applicant is a corporate, signature of duly authorized office . (Name and t~tle of corporate officer) t Location of Jgnd on which propose~J.work will be done Map No ...................... Lot No ' . .................. Street and Nu~er . l.¥. ~ ~.~.~.: .......... ~(~.~ ....................... Munici~lity 2. State existing use and occupancy of premises and intended use and occupancy of propos~ construction a Existing use and ~cupancy ..... ~..~.~: .................................................................................................. b Intended use and occupancy ...... .~.~.~.:'.Z/...~.~.... ~ ..~.~..~..~ ................................................... 3. Nature of work (check which applicable) New Building .................. Addition .................. Alteration ............... Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ....................................... 4 Estimated Cost ..~'..~J.~...~. ..... ~.~ ................................. Fee ......................................................................................... (to be pa~d on filing th~s application) 5 If dwelling, number of dwelling units ..~../...~..~.~. ....... Number of dwelhng umts on each floor ........................... If garage, number of cars ...... ~.;.........-"'-~. .................................................................................................................. 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use ' - 7 Dimensions of ex~st~ng structures, if any. Front ........................... Rear ................................ Depth .................... Height ........................ Number of Stories .... ~.~..-. ............................................................................................ Dimensions of same structure w~th a. lterat~ons or additions Front ...................................Rear ........................ Depth ................................ Height ........................ Number of Stones ............................ 8. Dimensions of entire new construction' Front .... ~..' .......................... Rear ............................ Depth.././...~. ........... Height ..~.../. ............. Number of Stories .... ~.. ,~..~. ............................................................... 9. S~ze of lot: Front-- ~.~..~Z,-:t~..~....~.'...~ ....................... Depth 10. Date of Purchase ................................................... Na, rne of Former Owner ....................................................... 11 Zone or use d~stnct in which prem ses are situated ..... ...CC...: ............................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation:) ..~.~4/~~ ............... t3 Name of Owner of premises D~.~.¢.? .~,?.....~"~.s..K..''. .... Address ..5:~.~..~i..?! ..... .~..~I~ ................ Phone No ................... Name of Architect ........................................... Address ....... :..~T.-~ ..................... Phone No .... ~: ...... Name of Contractor ~..~4td4C.s:.~7...4~/.:.~.q.~..~'- ~ ....Address j~.~-fi..~.j: .~.~.,.¢,/.c:. ....... ~:.,~.--'.. Phone No./~..~..:.~.'...~..~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oll set-b~ck dimensions fron property hnes Gwe street and block number or descnpt~on according to deed, and show street names and indlcat. whether interior or corner lot / STATE OF N~OR~,f .................... ~......~....~¥:.;~. ............. being duly sworn, deposes and says that he ,s the apphca, (Name of individual ~ning apphcat~on) above named. He ,s the ............................................... ~~./~......~ ...... ~ ~..: ........................... (C~? ~g~t, corporate--Uofficer, etc.) of said owner or owners, and ~s duly authonzed to perform or have performed the said work and te make and fi this apphcation, that ail statements contained ~n th~s application are true to the best of h~s knowledge and behef, a, that the work will be performed ~n the manner set forth m the application filed therewith Sworn to before me this ' ,/.~.~...~..~~:/~ ~i~'~'~r~ ot o~j .........................