Loading...
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 ) .........................