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Home My WebLink About3302-zFOR~ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. P. ERTIFIE:ATE OF EIP-E:UPANP. Y No...~...3.3.3..~... Date . .D.e.g.e..m~..e.=....4.,. ................ 19~..8.. THIS CERTIFIES that the building located at:~l~M~.~:.~V~...&l~.~aCh .l~.. Street ~er~ng aar~or Map No ............. Block No ............. Lot No...G.r.e..e~J~..r.t.~..N..ew...¥.o.r.k. ........ conforms substantially %0 the Applicati,on for Building Permit heretofore filed in this office dated ....N..Oy..e...~..~....2.~ ...... , 19..~.~. pursuant to which Building Permit No. 3.~.0.2...~.. dated ....N.o..v.e..~...~....4.~ ...... , 19.~..6., 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 .. RU..~.~.n..e.~.q..B.u..~.~.4 .~.n.~' .(~t..o.~.a.g.e...a...d.~.s.p.l.a.y. h~..d~: ) .................... The certificate is issued t.o . .H..~.l].~.y..P.~.e.q.h~.a..k.~. ...................................... (owner, lessee or tenant) of the aforesaid building. /~.t'-~ ' ~uffolk County Department of Health Approval ................................... 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? 3302 Z Permission is hereby granted to: ............... 63..~le~,b..~.t ...................................... ..... ~t4h~tau..~tat~ ~ ...... 1~.~. .............. to ~tl~ld..i~¥ ..Im~ a ..bulLd~.....lla~lla...lt~ra[a ..-...lal~ll..at~ .................... at premises located at .....JJ~.J~.....JJ~lJ,~,Jh..,J~&~. .................................................................................. ............................... G~v..It,¥.. ............................................................................................. pursuan,t to application dated .................................. ~[Q~.II~.~.....~, 19....~., and approved by the Building Inspector. Fee $. ,~,0.~.00. .......... Building Inspector FOR~ NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. APPLICATION FOR BUILDING PERMIT 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 propertymust 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 all applicable laws, ordinances, building code and regulations. -Co (Signature of applicant, or nome, if a corporation) ............ (Address of appl~ant) fJ State whether applicant is own , ssee, agent, architect, engineer, cto r,~ian, plumber or builder. .................................... Name of owner of premises ~ If applicant is a coj~orate~ signature of dul~l./y authorized officer. - (.~me and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ...~..~...~.~`~..~.~......~..~/.~.......~.....~.(.~:..~..f?...~..~.~..~.~...4..~.~~~.. Municipality -7~ ~',,.. ~' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~'.~..~l~v~'. b. Intended use and occupancy ~z~x~p~-~4~~°~~(~ ......... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4, Estimated Cast .............. ,/.~.~...o...O. ........... : .................. 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 occupancy, specify nature and extent of each type of use ~...e~..~....,~....4.~/cxZ 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 ...~O..i ................. Rear ...~.~ ................... Depth ..../..~...o.. ................. Height ............................ Number of Stories ............................ 9. Size of lot: Front ..... .~...~..~....'. ........... Rear .....~....~...~...i ............ Depth ........~.../.~ .................. 10. Date of Purchase ..... ~E~l~..~...../.....~.....~. ..................... Name of Former Owner ~,~.....~..:.....~...~..~,~,,~.~.. ........ 1t. Zone or use district in which premises are situated ........... ~..?..~.(../~...~'...~.,~'. ................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ....../V_....~.: ......................................... 13. N~e~ of Owner of premises~.~4~'~..~....~'~'~.//x',~/d'./'..Address ..~..~......~..~...~../..~......~....~....u~...7?..~..~on'~'e~..'~...~...~.. Name of Architect ...................................................... Address ............................................. Phone No ..................... Name of C°ntractor~j~.c..t~,...~hg.~.9.-~ ............... Address/..~..~.....--~....o...~A'.~.I~.~'...~.~..,. Phone No~.~c..'~..'..~..~...~'...7, PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block numbers or description according to deed, and show strd~t lnames and indicate whether interior or corner lot. ~~ ~J STATE OF NEW YORK~., ~-~, I.I/~' S S 'Z~ 1~ ~ ........................... being duly sworn, dep~e~ and says that he is the applicant .......~'~'-~o~ individual signing application) (Contractor, agent, co,rate officer, etc.)' of said owner or owners, and is duly authorized to perform or have performed the ~id work and to make and file this application; that all statements contained in this application are true to the best o~ his knowledge and belief; and that the work will be pe~ormed in the manner set fo~h in the app~cation filed therewith. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This apphcat~on must be completely filled in by typewriter or m ink and submitted in duplicate to the Buildin, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and giwng a detailed description of layout of propertymust be drawn on the d~agram which is part of this applicatio~ c. The work covered by th~s 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. Suc 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 Occupanc shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulattons, for the construction of buildings, add,frans or alterations, or for removal or demolition, as herein describe~ The apphcant agrees to comply with all apphcable laws, ordinances, building code and regulations ............... ..... ................... (S~gnature of apphoant, or name, if a corporation) ........................... .................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildc ..................................... ....................................................................................................................................... Name of owner of premises ./..7/~..~'..Ke...~'. .~.../.~ If appli/:ant ~s a cor~porate~ signature of duJ.y authorized officer. - (.~ame and title of corporate officer) 1. Location of land on which proposed work will be done. Map No' . ...........................................Lot No' . ................ Street and Number ...~..x~'~/~.~.~.~.~ .~.....~. &'~.....¥-...~.~..../~' .~..~. - '~'~'/g"~/"~'~ '4/'~"e'~'~..~..c;'.,p~'~-~,,/~/-e. 7 Municipality ~'-~/,~' ~' ~-~oc~,~D 2 State existinq use and occupancy of premmes and ~ntended use and occupancy of proposed construction: 3 Nature of work (check which applicable): New Budding .................. Addition .................. Alteration .................. Repair .................... Removal .................... Demol~tion .................... Other Work (Describe) ...................................... 4. Eshmated Cost ............... L~.~..°...~. .............................. Fee .......................................................................................... (to be paid on filing this application) 5 If dwelhng, number of dwelling units ............................ Number of dwelling umts on each floor ............................ If garage, number of cars ........................................................................................................................................... 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use ~..~A..~....-~...f...~..:...c~..~.', 7. D~mensions of existing structures, if any: Front .......................... Rear .......................... Depth ............................ Height ............................ Number of Stones ............................................................................................................... D~mens~ons of same structure w~th alterations or additions' Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ........................................ 8. D~mensions of entire new construction: Front .....-~...O..i ................. Rear ...~.~ ................... Depth ..../..~...o.. ................. Height ............................ Number of Stones ............................ 9. Size of lot: Front ..... .~...~..~-...~. ........... Rear .... ~..5['...~...i ............ Depth ........~'..~ .................. ~..~ 6- /¢.~ .................................................. 10. Date of Purchase .............. /.....: ........................... Name of Former Owner ~x'~.. 11 Zone or use d~strict m which prem,ses are mtuated ........... ~..?..~.f..~...c~...s.,~ ............................................................... 12. Does proposed construction wolate any zomng law, ordinance or regulation? .... ../V_....O.; ......................................... 13. Na[-ne" of Owner of premises~.~4(~..~.....,~g./4(~..~l'.(..Address ..~'..~......~..q.~...~..z/'...~..~....¢~...z'./..~..~o5~'~o~.~.:~.?..~..¢...~.. Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor~.~...c..~...~.!.c,.(~e~.~.~S ............... Address L¢:.......~....o..~.~..R¢..~.~....~..~ .... Phone No./~..~..:~...'..~.~..~..~. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex,sting or proposed, and indicate all set-back dimensions fron property hnes. Give street and block numbers or descnpt~on according to deed, and show street names and ind~cat~ whether interior or corner lot. "~.._.._. ~ STATE OF N~ YOR~ , ..~~~.~ ........................... being duly sworn, deposes and says that he is the app ica ....... (Na~lof individual signing apphcation) above ~amed.k~ffe is the .................... ~.~. ..... .~..~(~.~.~...g..~.~..~. ................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owne~, and th~s apphcation, that all statements contained m th~s application are true to the best of his knowledge and beli: and that the work wdl be performed m the manner set forth m the app~cation filed therewith. Sworn to before me this ................. ~.~doy of ........ ~-.~- ~. ~ .~,~ / PATENT I Z~PPLIED FORI 1'3 !I @ I