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Home My WebLink About3276-zFORI~ ~o. 4: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~RK'S OFFICE SOUTHOLD, N. Y. C:IE~TIF'II~ATI::' CIF' clr':c:U~ANC:Y No. Z 2718 Date ................................ THIS CERTIFIES that the building located at .~../'.~...C.e.~..~??..]....D~. ............ Street Capt Kidd Estates Map No ............. Block No ............. Lot No. 1~6 ~tt~tuck N conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... .0. q.~....1~., 19.6.6.. pursuant to which Building Permit No..3276..2~ dated ............... ~).e.~;...~LT., 19.66., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The occupancy £.or which this certificate is issued is ...a.e..eP.s..aP..z~..b..~..t.4~g..( .P~/~.. $.~.~ge bl.dg, f.~r..c~wt%er~..us.e, only).. The certificate is issued to . .~..h.~.~...$.~...~.e.n. gqp.i.s. ......... .0>..~..e?. ...................... (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval ...................................... ..... ..... ......... Building Inspector ~0~ NO. ~ TC~VN OF SOUTHOLD BUll~DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~{~-;~:.::~; ~Porm!~sion iS hereby granted to: BUILDING FERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK ^UTHORIZED) Dote .......... . ,~.......C.~, ... ,?.. ......... .~....,.?. .......... ,' 19...~...~' pursuant ,to application dated .............0...~....~.,.....~.....~i ............. , 19.~....~., and approved by the Building Inspector. Fee $......~... ............... Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... ........ Approved ......................................... ] 9 ........ Permit No ................................. D~sapproved o/c -..-........._z..,:..'.: .......... ~ ............... ~ ........ Application No ........................... APPLICATION FOR BUILDING PERMIT Date ....................... ~....ff......'~.. ........... , 19..(...~..... INSTRUCTIONS a Th~s apphcohon must be completely filled m by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b Plot plan showing location of lot and of buddings on premises, relobonship to adjoining premises or public streets ~ areas, and g~wng a detailed descnpt~on of layout of propertymust be drawn on the d~agram which is part of th~s applicatio. c. The work covered by this opphcation may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the applicant. Su~ 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 Occupant shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to t[ 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 alterations, ar for removal or demolition, as hereto describe. The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) .... ............... (Address oW applicant) State whether apphcont is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build: ...................... ................................................................................................................................................ Name of owner of premises ........ ' ................ ./.~ ...................................................................................... If applicant ~s o corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No ............................................Lot No' . ............... Street and Number ............ /...,M.~.....&.~'~,~...~!.~..~....~...~.~Z/~..~..~.~ ...... ~.~..~..~ .~.~.....~..~.f.~.~./.~..~.. Mumcipolity t State ex~stsng use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ..... ..~'...0. ~..!.~..~v..A~....?..J..~/..~.. ....................................................................................... b Intended use and occuponc¥ .... .0~.~.~.,~..~...~.. ......... ~...~...~...~...,' .................................................................... 3. Nature of work (check which applicable): New Budding ...~.. ........ Add,ban ................. Alteration ................. Repmr .................... Removal .................... Demolitmn .................... Other Work (Describe) .................................... 4. Estimated Cost .....~..~,,,;Z~. .......................................... Fee ........................................................................................ (to be paid on filing thru apphcation) .5 If dwelhng, number of dwelhng units ......... ~ ............... Number of dwelhng 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,mens~ons of existing structures, if Qny: Front ,~.~....~...~.~....:/.... Rear ....-~?~....:..'T.~.-?..i.~.. Depth ,(~.~...(..-..,~....; .... He,ght/~...~..O..?¢.~....~..... Number of Stories ..._~....~..~... ............................................................................................. DJmens,ons of same structure w,th alterot,ons or addit,ons: Front ~'~,~-.~;~./'~.~_~. ............ Rear ..~'.~..~. .......... Depth .a~.~.Y~....;~..?~ .............. Height ...~-~.':..,~...~....~ ............ Number of Stories ....?..~}z'k~..~.. .................. 8. Dimens,ons of ent,re new construct,on: Front /.~..~...~.O..~ ......... Rear J..~. ....... .%0. .......... Depth .~.'...-z...~..:L ......... He,ght ..~..~..Z..~..L~. ......... Number of Stories ..J. ....................... 9. S,ze of lot' Front .....~...~...~..: .......... Rear ....~.~..-~-_.~.. .......... Depth ..,/~..~....~?. ............... 10. Date of Purchase ....................................................... Name of Former Owner ...................................................... 11 Zone or use distr,ct ,n which prem,ses are s,tuated ..... :...~..';...~'~..c?.¢~.i.~..~...~...¢.J.~ ..... 12. Does proposed construcbon wolate any zo~nlng law, ordinance or, regul¢ion? ...~. ........................................... Name of Owner of / / /¢~:~r~-io¢~ l- :~. ..... Name of Architect ...................................................... Address ......................... :. ................. Phone No ................... Nome of Contractor .................................................... Address ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and d~stinctly all buddings, whether ex~st~ng or proposed, end indicate all set-back dimensions fro, property hnes. G~ve street and block numbers or description according to deed, and show street names and red,ca. whether ~ntenor or corner lot. STATE OF NEW YORK, COUNTY OF .......... t s.s Christ Ren~.g..e.~...i.~ .................................. being duly sworn, deposes and says that he is the applio (Name of individua sigmng apphcabon) above named. He is the ..................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and th~s apphcat~on; that all statements contained in this application are true to the best of his knowledge and beli and that the work wdl be performed in the manner set forth m the apphcation filed therewith. Sworn to before me this lCth , - October ,o 66 , --~/; _z- /D , .................... 4. .... aay or~ ........................... ~ ~.~.z'/~'~= ...... · ...... ' ~ 7 ........ /.~ (.~¢fCef~: .~<fc'../~/lZ ~ -" ~.l..~r'.~,~..~..~'~-- ~ ~' Notary Public, . ........................... ~5 ............ County. ..... .~ (S~gnature o~pplicant) i