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Home My WebLink About3254-zFOR~ 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. [~EETIFIEATE nF 13ECUPANGY No. Z '2b~ .... Date ............ ~fd~;' '~8 .......... , 19.~ THIS CERTIFIES that the building located at ............................... Street Cedal, Beach Park Rd Ma~=. ~a~' ~ck No ............. Lot No ................................... herO're ~e~in t~is office conforms substantially t,o the Application for Building ~rmit ~ O~ ~ dated .......................... 19 .... pursuant to which Building Permit No .......... dated .......................... 1 .., was issued, and conforms to all of the r Oot 3.. merits of the applicable provm]ons o e law. The occupancy for which this certificate is issued is ............................................................................... Private one fa~il~ dw~ll~-~g The certificate is issued t,o .............. V'J .......................................... Dr, F, Burke (o~lrssee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... lq.' ]~ ...................... TOWN O~ SOU~OL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL ~ULL COMPLETION OF THE WORK AUTHORIZED) N? 3254 7_. at premises located at .'JJJ¢~..l~. .............. J~]L'..4~8,IIJ~..~iJ~ ......................................................... pursuc~$ to application dated .......................... ~t .......... ~. .............. , 19~..., ond approved by the Building Inspector. tee $~.'~J~ .............. Permission is hereby granted to: ....... FORM NO. 1 ~t Approved ........................................ , 'TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. 19 ........ Permit No .......................... Application No Disapproved a/c ~ ............ ~ '~ ............................ i ..... APPLICATION FOR BUILDING PERMIT Date ~'~q'~ "';~ ..... · ~....J..; .......................................... , 19 .~..~ INSTRUCTIONS a. This apphcation must be completely filled ~n by typewriter or ,n ink and submitted m duplicate to the Bu~ldi~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relat,onship to adjoining premises or pubhc streets areas, and g,ving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio c The work covered by this application may not be commenced before issuance of Building Pertain d Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the apphcant. Such perrr shall be kept on the premises avmlable 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the Issuance of a Building Permit pursuant to 1} Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or afterat~ons, or for removal or demolmon, as herren describe, The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. ~'" (Signature of applic~,'or name, if a corporation) (Address ot; apphcant) ' State whether apphcant~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~Idc ............................ ...... ............................................................................................................ Name of owner of premises ........................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on wb~h pro, posed work w,II be done Map No' Street and Number .~...~...~......~...~.......~.....~....~........~.....~...: ........... ~i.:~ ....... '" Municipality 2. State existing use and occupancy of~remises and intended use and occupancy of proposed construction a. Existing use and occupancy .... ~..~.'rj ......................................................................................... b. Intended use and occupancy ................ ~ ................ ...~...../........~......~...~ ................................................. '"j 3. Nature of work (check which applicable): New Building .................. Addition ...... ~... Alteration .............. Repair .................. Removal .................. Demohtion .................. Other Work (Describe) .................................... 4. Estimated Cost .......... /...~....¢~:T~. .................... Fee ....................................................................................... (to be paid on filing this application) 5 If dwelling, number of dwelhng 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 ........................ 7 D~mensions of ex,sting structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ............................................................................................................. D.'nensions of same structure with alterations or additions. Front .................................... Rear ......................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ./.~.. ................... Rear ............................ Depth... -/ ~' Height .................... Number of Stories ............................................................................. 9. S~ze of lot: Front ............................ Rear ................................... Depth ............................... 10 Date of Purchase ....................................................... Nome of Former Owner ...................................................... 11 Zone or use district in wh,ch premises are s~tuated ............................................................................................... 12 Does proposed construction viofote any zoning law, ordinance or reaulat~on~ ...................................................... · '~....~..~....~./~f~.~...Addres~'-~"~~ ~ 13 Nome of Owner of prem,ses ....r. .... .... ¢...~...... ....... ~,...~..¢~hone No ................... Name of Architect ....................... ; .............................. Address ....~ ........ ~_...j._,)/~ .......... Phone No ................... Name of ~~ Contracto/Z~.Z ..... ...~..:.~..~....Address~w~?.~..~..'~..~.~ Phone No .s~..j.?~-..~...~..~ PLOT DIAGRAM Locate clearly and d~stinctly all buddings, whether ex~stmg or proposed, and mdmate all set-back dimensions froi property hnes Give street and block number or description according to deed, whether interior or corner lot. and show street names and indma~ STATE OF NEW,-..YORI~/ a Jr' ~ e ¢ COUNTY ~.'.~ ...... ~ ~"~' ................... ~ .............I.~.....,..~. ~.~.~...~,:~,::: ......... being duly sworn, deposes and says that he is the apphc~ · ' ~'~'1' signin~Japplicahon) above named, He is the ......."'"" .......... -'~-' ~'- ~~,~~.%. ......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and - this application; that all statements contained in th~s application are true to the best of his knowledge and behef; that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ................ ~.... day of ...~.~ .......... , Notary Public, ~/~.,/~.~ .~.~.~,~...4..,..//~..~,./~_,_.Z.~. ......... County// (Signat~/'e of applicant) Term Expires IvL~ cn ,