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Home My WebLink About3271-zFOF,~I 1~0. 4 TOWN OF SOUTI-IOLD I~UILDING DEPARTMENT '~OWI~ CLERK'S OFFICE SOUTHOLD, N. ¥. I~I:'I:tTII:'II~ATE Ol:' IiiIiII~UPANIiI¥ THIS CERTIFIES that the building located at . .~/S-lq~.~,0~,(~.tt].. Street Map No.]~t~; ...... Block No .... ~ ...... Lot No. ~ ...... ~O~..N,.~, ....... conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated ........... 0~t .... ~..., 19.(~ pursuant to which Building Permit No..3~-~.],. Z dated ............ 0~;-' .~br..., 196~-, 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 . .P~tvate. ~n~ .fa~ll.~. d,~l~ ...................................... The certificate is issued t.o . l~;e~l~ ~k ..... ~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... .~?...~.e. ........................... Building Inspector FOR~[ NO. 2 TO~N OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PEIUVilT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3271 Z Permission is hereby granted to: to at premises located at .... ~r&t~.~4~ .......~l[~l~,..PO:~t; ......................................................... ..................... ~- .................. ~,t~;t4r.,~,.~.'. ...................................................................................... pursuc~t to application dated .......................... t~ ........... ~1~. ......... , 19..~1~, and approved b~y the Building Inspector. · ding Inspec~c~ FOBM NO. ! TOWN OF SOUTHOLD BUILDING :DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. Appro¥~d ........................................ , 19 ........ Permit No. ~ ......................... -- Disapproved a~ '" .....i.i ........ (Building Inspector~' APFLICATION FOR BUILDING PERMIT Date ...~.~ .......... .f....?. .................. , ~'~' INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which s port of this application. 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 applicant. Such 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 in part for any purpose whatever until a Certificate of Occupancy ' 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ~'~]~ ~'~~ ~'~~/~/~' ~-~,~ ~ ordinancqs, bui~ling code apd regulations. . · ........ (Address or applicant) State whether applicant is ownerf~ le es~see~g~.., Lrchle~ee, a e , architect, engi'neer, general contractor, electrician, plumber or builder. ~'~'~' '~i '~e r of premises ~ ~ .................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be doneI Ma~ No.: ............ .....~.. ~ ........ Lot No.: .~....?.....~.. ........... Street and Number ..... ~-....~:......~......~z...-..~... ........... ~-....~.-..T~i~il~-i]~/...: .................. ".." ........... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... ~ ....................................................................................... b. Intended use and occupancy .................. ...~....~...~ ............................................ ~. Nature of work (check which applicable): New Buildin~':~; ............... Addition ....x'~.. .....Alteration .................. Repair .................. Removal .................. Demolition..; .............. ; O~her Work (Describe) ........................................ 4. Estimated Cost ............ l~....~ ............... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ....................................................................... :~,...~..: .......... ~.~ ........... ~,~...~:,,:, ....... ......... 6. If business, commercial or mixed o?cupancy, 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 alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ ...~.....~.../. ................ Rear ............................ Depth ...~......~_...~. ........ 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 construction .vi.~te_any~ zonin~ law, ordinance or 13. Name of Owner of premise~s~-~C~n.~.~.*,.~....~ddress~.~'~....~J>bene No. Name of Architect ~ ................................... ~ ....... :.....Address ....... ,e .................................. Phone No ..................... Name of Controc~..~.....Addres~'~.'i..~Phone No.~..o..~.~..-~..~.~' "" PLOT DIAGRAM Locate clearly aod distinctly all b~il~lJngs, whether existing or proposed, and ndicate al set,back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior o~ corner lot. STATE OF NEW¥ORK, ,.~ ~, , COUNTY OF~~*'~' · li~i~i ................. being duly swo?n, deposes.and says that he is the applicant above named. He is the ............................. r ........................................................................................................................... (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 file this application;, that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application, filed therewith. Sworn to before me this · ....... ......... day of ...... ............ , .Z _ W.., ~ARION A. REGENT.(/ ~ NOTARY PUBLIC, Stal~ of ~ew Yo~l~ , 3'errn ~xpJres ~rc~ 30, ~g_~ ~