HomeMy WebLinkAbout3214-zFORlVl 1~O. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
CERTIFICATE OF Or.r. UPANr. y
No..ii;..~02.Q... Date ... ~.~1..4, ................. 19.68.
THIS CERTIFIES that the building located at .P..tnr~haha. Blvd. .......... Street
Map No ............. Block No ............. Lot No. Southo],c!,..I~.L.,.
conforms substantially ~o the Applicati.on for Building Permit heretofore filed in this office
dated ..... l~epi:o6 ............. 196&. pursuant to which Building Permit No.
dated ..... $~pt:,..8 ............ 19. ~6, was issued, and conforms to all of the require-
ments ~of the .applicable provisions of the law. The occupancy ior which this certificate is
issued is ..... pZ'~V&t:~e .one. ;[~smil. y..clw~ltng ......................................
The certificate is issued t,o ...... A,~l~a~tt. ~o. ~], .... ~rlel:. ........................
(owner, lessee or tenant)
of the aforesaid building. //~ ~
,Suffolk County Department of Health Appr, oval ...............................
Building Inspector
FOI~M 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? 321~ Z
Date ..J~..~t, elBblJJ' ~ 19...~..
Permission is hereby granted to:
~,,tl~,r~__~,- ~.a.....~-b~t,..~.~ ..
........... ~z..~.~ ......................................................
at premises located at ..~.~,,.I~I4~..)~L~.~J~ ..... ~~..g'~,:l;~t ................................................
............................................ · ~t~f,~!~J ~ ..... 1I,¥., ...............................................................................
pursuant to application dated ................................ ~)~....~ ............ l~J~...., and approved by the
Building Inspector
Fee ~.00 ................
FORM NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD,
N.
Y.
Approved ........................................ , 19 ........ Permit No ............................... ;.'
............................... ........................
Application No. 3 a~- I ~-~'
APPLICATION FOR BUILDING/~IT
Date~.....~.. ............................... ,19..(?...~.....
INSTRUCTIONS
o. Th~s application must be completely filled in by typewriter or ~n ink and submitted in duplicate to the Buildin~
Inspector.
b. Plot plan showing location of lot and of buildings on premises, relationship to adlommg premises or public streets o
areas, and gwmg a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatioe
c The work covered by this apphcat~on may not be commenced before issuance of Building Permit.
d. Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant. Sucl
permit 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 ~n part i~or any purpose whatever untda Certificate of Occupanc
shall have been granted by the Building Inspector
APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to th
Buil&ng Zone Or&nance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c
Regulations, for the censtruction of buildings, ad&tions or alterahons, or for removal or demolition, as herein described
The applicant agrees to comply with all apphcable laws, ordinance, building/r~ ap~regulations.
...............................
~-L. (Signature of applicant, or name, if a corporation)
(Address of applicant)
lent, architect, engineer, general contractor, electrician, plumber or builde,
State whether applicant is owner, lessee,
Name of owner of premises ....~...J'...~....~'...~...~.. ....... .~.L/.(.J~.~..~.. .................................................................................................
If applicant ~s 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 .../~...J. ff..~...~..~..4~..~..~.. ...... .~...~..~f ............ 5.?...~..~.../'(.°.?....~. ........ ..~..:..?.: ....... ../~..~....~..I .........................
Mumc~pality
2. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction:
a Exist,nfl use and occupancy j~b"~/,~ ~/'I/C' ~
b. Intended use and occupancy .............................................................................................................................
3 Nature of work (check which applicable)' New Building .................. Ad&tion .................. Alteration .................
Repmr .................... Removal .................... Demolihon .................... Other Work (Describe) .....................................
4 Eshmated Cost ............................................................ Fee .........................................................................................
(to be paid on fihng th~s apphcation)
.5 If dwelhng, number of dwelling units .~ ......................... Number of dwelling units on each floor ~ .........................
If garage, number of cars ..........................................................................................................................................
6 If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use ...............................
7 D,mens~ons of existing structures, if any: Front..~.....~..(. ............Rear .~..Z../. ............... Depth ..~.....~.... ............
Height/~' Number of Stones '/
Dimens,ons of same structure w,th alterations or add,tions Front ................... Rear ..................
Depth ..3.~...r'. .................. Height .....2..~. ................... Number of Stories .[.. ....................................
8 Dimens,ons of enhre new construct,on' Front ~.. j~x ! 'Rear ~r Depth .~....~....[ ..............
/ r
Height .... .~. ..................... Number of Stories ./. .........................
Rear ....~....~.. ................. Depth ...............................
9 S~ze of lot Front .....~..~..' .................
10. Date of Purchase .... '~...~..~..~... ................................... Name of Former Owner .~..~...~.~....~.~'.~./.~Z~.. ..................
11. Zone or use distr,ct in which prem,ses are s,tuated....~..2~.....~.z~r..~.~..~....~2~..~...~..~ ........................................
12 Does proposed construction wolote any zoning law, ordinance or re lation? ../~J....0. ..........................................
13 Name of Owner of premises .2~r..~..~...~.Z...d....*..~ddress ../~.ff/.~..~..~.~;!~../~l.~..~tl[..~../,{.,Phone No ....................
Name of Architect ...................................................... Address ............................................ Phone No ...................
Name of Contractor ....
whether ~nterior or corner lot.
PLOT DIAGRAM
Locate clearly and d~stinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fron
property hnes. Give street and block numbers or description according to deed, and show street names and indicat,
J
STATE OF NEW YORK, '~ ¢ c
.......... ,
...~..~_~ .................................... being duly sworn, deposes and says that he ~s the applicon
r~' (Name of individual signing appl cation)
above named. He is the ................ ~.~ ......................................................................... ~ ....................................
(Contractor, agent, corporate officer, etc.)
of smd owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and
th~s apphcation, that all statements contained m this opphcat~on are true to the best of his knowledge and behef
and that the work wdl be performed in the manner set forth in the,eRphcation filed therp.~vith.
Sworn to before me th~So~,~ -- 19
............ ......
Notary Pubhc,~'~~ ~ ( g pp ) .........................