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Home My WebLink About3270-zFOl~I 1~0, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD. N. ¥. IZI~I~TIFIIZATIr rIF rIIZIZUPANIZY No. ~ .~].{~ .... Date ............ I~'ga~bIX*...2{~ · ·., 19. ~ THIS CERTIFIES that the building located at ~yt{~ .A~k~l'~r. ~.O~ .~...'.. Street Map No...~Jl; ....... Block No .... ~l~ ...... Lot No..~131Z .... 1~%~,~{~].4~. 1~ ......... conforms substantially t,o the Applicati.on for Building Permit heretofore filed in this office dated ............. 0(~;O~l~..~ 19. (:~ pursuant to which Building Permit No..~L~0. Z dated ........... 0~I~; .... l~, .... 19. '66 was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy for which this certificate m issued is .P2'~V&~e. o~e. ,i'a~il.~ .~vell.-~l ....................................... The certificate is issued t.o . .~elt.~,'.~Oll ......... 0~,rllel, ................................ (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Appuoval ............. ][l~...~t ................. FO~ NO. ~ _~TOWN OF $OUTHOLD BUILDING DEPARTMENT' TOWN GLERK'$ OFFICE : SOUTHOLD, N. Y. BUILDING PEIU~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION oF'THE WOI~K AUTHORIZED) 3270 Z Permission i~s hereby granted to~, ........... at premises located at .:.Jl~.~..~r.~l~...~l~..~St~:l~ .......... ; ........................................................... .......................................... :..- lte~'t;t~e~ ir ....~,,'~,, .............................................................................. pursuan~ to application dated ........................... J~ ...... ~ ............. , 19.tJ~., ~and approved by the Building Inspector. FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .........;..:~.,..~':...../....q./ ...... , 19.~.(~. Permit No ..~....~.....~...(:~....'~ Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMIT Date ....... ....~....~ ........~......'~... .................. 19...~.....~.. INSTRUCTIONS a This application must be completely f~lled m by typewriter or m ~nk and submitted m duplicate to the Bu~ldin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc streets c areas, and g~ving a detailed description of layout of property must be drawn on the d~agram which ~s part of this applicatior c. The work covered by th~s application may not be commenced before issuance of Building Permit. d Upon approval of this apphcat~on, 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 ~n 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 issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demohtlon, as here~n described The applicant agrees to comply with all applicable laws, ordinances, byilding code and regulations. .//'(Signg.t. e of ol~phco~'or name, if a corporation) (Address of'6pplicant) ,0/ State whether opplicant~ch~tect, engineer, general contractor, electrician, plumber or bu~lde, Name of owner of premises ....... i..~....Z~ .......... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1 Location of land on which proposed work wzll be done Map No · . ................................... Lot No: ....................... 2 Street and Number .............................................................................................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o Ex~sting use and occupancy .................................................................................... 3. Nature of work (check which appllcable): New t3uddmg ................. Addition . ..~.. .......Alteration ............ Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost .... ~.~.~.~. ..... ~ ........................ Fee ...................................................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units ............................ Number of dwelhng un,ts on each floor .......................... If garage, number of cars ........................................................................................................................................... 6. If business, commeroal or mixed occupancy, specify nature and extent of each type of use .......................... 7. Dimensions of existing structures, if any: Front ........................... Rear ................................ Depth ................... Height ........................ Number of Stories ........... ~..~../¢~. .............................................................................. Dimensions of same structure with alterahons or odd,hans Front .................................... Rear ......................... Depth ................................ Height ............................ Number of Stories .............................. Rear ..... ./....~.. ............... Depth .../...~..~ 8. Dimensions of entire new construction: Front ............ .~... ....................... Height .................... Number of Stories ...........(~~ .................................................................................. 9. Size of lot: Front ............................ Rear ................................... Depth ............................... 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construchon violate any zoning law, ordinance or re.~ulahon~ .......................................................... t3. Name of Owner of premises ~./....~ .............. Addres~-r,~--~"~...~....~hone No Name of Architect .,~¢~ ............................................... Address .....;~. ................... ., .............. Phone No ................... Name of Contra ....... Addre Phone No c~.~...-..~.. PLOT DIAGRAM Locate clearly and dmtinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro~ property lines. G~ve street and block number or description according to deed, and show street names and ind~cat whether interior or corner lot. STATE OF NEWJ~.OR[(,~ . ~., 1 COUNTY OF~J' S.S. ..~ ....... .................... ................................. being duly sworn, deposes and says that he is the opplica /~/ (Name ~f md~'(Jual signing apphcation) above named. He is the .................................................................................................................................................... (Contractor, agent, corporate officer, otc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and f this application; that all statements contained m this apphcat~on are true to the best of his knowledge and behef; a that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this _ ~ ........ .... day of ............. . ~ ~. ~' ._2 , ..... ,7~'.~.~..~..~....,Z.~/~¢~..~...~C.. ................... Notary Public, ...~~......~..:...~Co~un~y. ~ ~ Z (~ignat~.r~'-of applicant) NOTARY FU3LI~, State o( ~' e~ Yor~ ' ~' Ito. 52-323J120 Suffolk County '[erm Exp/re~ M~rch 30, lg_~7 ~