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Home My WebLink About2971-zTOWN OF SOUTHOLD EUILDING DEPARTMENT '~'OWN C~-ERK'S OFFICE $OUTHOLD, N. Y. r. ~' RTl F~ OAT~- OB' No. g.. 2.~31 .... Date ................ ~.~e.... 3 ...... ~9.66. THIS CERTIFIES that the building located at . R,0~,I~,..I~.,/8..~lglo~.S. Rd.. Street Map No.. ~,.lC ....... Block No... ~ ....... Lot No. :X~ ..... I~reP, Bt~o~l;~..I~l~.3[e ...... conforms substantially ~o the Applicati,on for Building Permit hereto~are filed in this office dated ............ ~.ala,....~.,. 1,9~:0,66. pursuant to which Building Permit No. 29~ .g. dated ............. .fig.ri...1~..~..., 19.6.6., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The occupancy for which this certificate is issued is ~.r~L~a~. olle. f. alll:tly. ~we.,],lil~g ........................................... The certificate is issued t.o . liltS..I~a~.. (~.llil:lie~ ..........0rv~eI~... .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... I~..ay...~..~.,. ~.9.6.6....by.. R.*...V.i.~..1.~.... Building Inspe~[tor FORM NO. 2 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERICS OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2971 Z Permission is hereby granted to: Building Inspector Fee '~ Building Inspector SUFFOLK COUNTT DEPAE]~MENT OF HEALTH TO WHOM IT MAY CONCERN: H1_dg., Pe~a~[%, No. ~. The sewage disposal facilities for a structure located at have been inspected by this Department and found to be satisfactory. District Engineer District Engineer FO~M NO~ 1 TGWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....,~<~;~.-~..;_~..~,~_ _'~'c% 19 . Approved .................. . ........ ! ............. , 19 ....... .. Permit No...'~'....~..~...~_~ -' -~isapproved a/c ................... ~ ......................................................... Application No. a.../....t../ ............. (Buildin~ Inspector) APPLICATION FOR BUILDING PERMIT ....... ......... ............................ , ......... INSTRUCTIONS a. This application m.(~t be ~ompletely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. ' b. Plot plan showing'lo0btion of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed~descriptlon of layout of property must be drawn on the diagram which is pa,rt of thie applicat on c. The work covered ~/this application may not be commenced before issuance of Building Permit. d. Upon approval of ~s opphcabon, the Building Inspector will ~ssue a Bu drag Permit to the app cant Such permit shall be kept on the preMi~es available for inspection throughout the progress of the work. ' e. No building shall t:/e occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by t,~e Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinan¢)~' of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the c~J~istruction of buildings, additions or alterations, or for removal or demc~lition, as herein described. The applicant agrees to comply with all applicable laws ordinances, I~}lding,code and regulations· · State whether applicant .............. Gu.~Z... ~o~d...Lane.,...G~:emnl~.or.~ ,.~] ,.Y., ........... (Address of applicant) ? is o~ner, lessee, agent, architect, engineer, general controctor,, electrician, plumber or builder. Name of owner of premis~s ...... l~..~lI~.rt..i.~.0 ................................................................................................................. /If applicant is a corporcj}e, signature of duly authorized officer· (Name and.ylitle of corporate officer) 1. Location of lo~d ~bn which proposed work will be done..Mop No.: ........................................ Lot No.: ........................ Street and J~bmber ~1 '0£~ I~£e~ ~ ,p '[~ · ................. ~';'"':":'"','.: ......................................... 2. State existir~ use and Occupancy of premises and intendec1 use and occupancy of proposed construction: o. £xistin~~use end o¢¢uponcy ~11~ ..... Intendtduse ,/~/rll and 'occupancy ....... :~OUSe ................ ~'" .......................................................................................... 3. Nature of work (check which applicable): New Bui~di~Ig ....... .~ ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demo t on ................ Other Work (Describe) ........................................ 4. Estimated Cost ....... ~6'~'~0(}; ................................. :ee ......... 1' ........................................................................ ~<~1~11~ paid on filing this application) 5~ If dwelling, number of dwelling units ..... '1' ............ / ...... Number of dwelling units on each floor ..$...r~l~l ......... If garage, number bf c¢lrs ..... ,n~'~ ...................... ~ ........................................................ ~ ............................................. 6. If business, commercial or mixed occupancy, ~ecify 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 oF additions: Front .......................... ~,l ........ Rear ............................ Depth ................................ Height ...................... ' ...... Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... .~.9.' ......................... Rear ..,.3.9.~..... ........... .. Depth ..... .25' ............. Height .................... Number of Stories ...........'1. ..................................................................... i ................................... 9. Size of lot: Front "g~1'-'79 .............. Rear ...... ~, .................... Depth ....96v4-6.,on...~.i.?l 10. Date of Purchase ..... ~St="~"lg6$' ................... Name of Former Owner .~.t~'...l~.¥ko~.t.t~l~ ...................... 11. Zone or use district in which premises are situated ....... R~'$i.~I'~$~'1 ................................... ................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ....i~ ................................................... 13. Name of Owner of premises ...:[~lry'~..~¢l+~' ....... Address'"5;~,~'" ~.... ~.; ..... Phone No. .................... Name of A~'chitect ...................................................... Address ................................... : ........ Phone No ..................... Name of Contractor . .~m~l~,~l.~t,..~l~tn. .............. Address ...~,~[mort,.~l',.~ ........ Phone No....~r~.~.o~ PLOT DIAGRAM Locate clearly and distinctly oll buildings, whether existing or proposed, and indicate oll set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STALE OF NEW YORK, ~ ¢ ~ COUNTY OF ....... ~n,~o'i ~ ........ f' .... I ........................................................................................ being duly~worn deposes and says tbet he is the applicant ~n~ l'lo~ i n~'~lc~ ~g n i n g application) '"- ~~~ above named. He is the .......... ~en"~r~or .................. ~~~'".~ ~ (Contractor, agent, corpOra~fficer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oil 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 be fo re me this 66 ~,~ .... .......... A ........... day of ............ ja~ ............. ,19 ........ ~~ ,, ,,,~,~ . , ~.. ~ .~_~......~,....~ .. Notary Publicfl~g~~ounty ""''~'~';';turo of applico~~ 52-G818~00 ~ t .~ ~ Z~/ ....................... t .....