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Home My WebLink About3003-zFORM NO. 4- TOWN OF 2OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E:ERTIFIP. ATE OF DP.P. UPAND¥ No. ~ .2~5'Z .... Date ............. .~ove~e:~,. -2~ 19 6?. THIS CERTIFIES that the building located at .I~/I[1, . '~'~.'a~-% L~e ....... Street Map No...:K~ ..... Block No.. ~ ........ Lo~ No. ~;y~:~ .... ~)~'t~I~.--N~.~ ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ Fe~ ..... ~..., 19.~$. Dllrsuant to which Building Permit dated .......... Fe~) .... ~ ..... , 19.6~., 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 . . PI'~-'VIl~;e 'o~8' 'i't~l~'~;y ' ~'~.i,t~lg' ..................................... The certificate is issued to ·' '~gllt' ila~ ........ i4~l~l~e~s~se4' ;~'t'e'~l~t') ......... o[ the aforesaid building. Suffolk County Department o~ Health Approval ...... N~. ~? ........................ Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MuST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3003 z Permission is hereby granted to: ~¥-..~ez~-;h~....-A/~--...D~:~,h~...~[er, ......... .......... O;~.~,e~ ~, ~....]i~ ~ ~. ......................... ,.,.....: ....... at premises located at ..~q[.~g~...~. .................... 7.......?,,:..,..,:..:.p; ........... :..:.......; .......... :'.v.' ...... ............................... O~.~.;....~f~.~....:...'..::........L,.......:.::L:,..~.::;..;..~.,..~,~ ....... :.., .......... : ...... :...:: ..... - ............. ; ........ 7-' ...... ' ....... T'?:": ...... '" "~';:"?:"Z"','"'"'~:~'" '?T~::;'?;;':z~':"t~ ?f" "?"'?'"?:'"':?'"7' . Building Inspector ~ - , ~ - , ' ;. ';' ~' . ' ~': Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ~1. Y. Approved ........................................ , 19 ........ Permit No ............................. Application No...~...?....O...~. ............. Disapproved a/~~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ........................ ........... ..... 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 is part 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 al applicab eaws, ordinances, bui ding code and regulations. ...... ........ (Address of applicant/) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... q .............................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and tltle of corporate officer) 1. Location of land on which proposed work will be done. ~Map No.: ........................................ Lot No.: ........................ Street and Number ....................... ~ ........................................................................................ ~ ............................. Municipality 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 ~t 3. NatL Repc 4. Estin 5. If dx If gc 6. If [ 7. Din' Hek, Dim Dep 8. Dim Hei! 9. Size 10. ] 1, Zen 12. 13. Nan Nan Nan L.ocat~ property Ii whether STATE OF COUNTY abow,' nm of said this appli, that the Sworn to ..... Notary re of work (check which applicable): New Building .................. Addition .................. Alteration .....i ............ ~r .............. '~7' Removal .................. Demohhon .................. Other Work (Describe) ........................... ~ ............ ,ated Cost ~.~'.../)i.~...?..?..,...°....O. ................................ Fee ............................................................................. i ............ (to be paid on filing this application) ,oiling, number of dwelling units ............./. .............. Number of dwellin§ units on each floor ...../. ....................... rage, number of cars Jsiness, commercial or mixed accupan'cy, specify nature and extent of each type of use ............... i ............. ~nsions of existing structures, if any: Front ........ ~..9..~..&...~.'. .... Rear ..... .~.?...~.~.~ ........... Depth .... .z~.. ............. / ~- ~t ...... ./...~.~ .......... Number of Stories ......... ~ .................................................................................................... ;nsions of same structure with alterations or additions: Front 3 ~z~ ~, Rear ~ /crc 'h ....... .~..?..! ................ Height ...../...7. ................... Number of Stories ....,/.....~m., .................. ensions of entire new construction: Front 3-'//," Rear ....~..:..~...~f ............ Depth ..,..?..f ............... iht ~' ' Number of Stories ....... /. .............................................................. of lot: Front ~ 2~ Rear ...... .~.....~.../ ..................... Depth / ~' ~' / of Purchase ........................................................ Name of Former Owner ........................................................ or use district Jn which premises are situated proposed construction violate any zoning law, ordinance or regulation? ...'~ .............................................. ~e of Owner of premises ..~..~...~ ................... Address ....... ~,~..~ .................. Phone No. ~ ........ ~e of Coniractor ....~.....~...~ Address Phone No.~..(~.~,.:../..~..~]. PLOT DIAGRAM , I clearly and distinctly all bu'ldings, whether existing or proposed, and indicate all set-back dimensigns from ~es. Give street and block number or description according to deed, and show street names andl indicate erior or corner Jot. NEW ,Y, aRK, } ~, ' DF ..,6..//..~..~.¢/.,¢~. ......... i.,f ~'~' J..~......~'~.~...,~..t~.~,~...~.. ....................................... bran0 'duly sworn; deposes and says that he is the applicant Name of individual signing application) ,~d. He is the ............................. ~.~...~ .~..ff.,~..C.. ~.,?.'x~.. J (Contractor, agent, corporate officer, etc.)I her or owners, and is duly authorized to perform or have l~erf0rmed the said work and to make and file ;arian; that all statements contained in this application are true to the best of his knowledge and belief and ark will be performed in the manner set forth in the application filed therewith. ,'fore me this ; ...... dayof ......... .~-..~ .~. ......................... , 19.~...~. ~~S ~~). · ..................................................... blic, . ....... County ignatu FLOYI) F. KING, JR~ NOTARY PIIBL lC, State of New York