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Home My WebLink About3015-zI~ORM 1~O. 4 TOWN OF SOUTI~IOLD ~UILDING DEPARTMEI~T 'I'O~VN CLERK'S OFFICE SOUTHOLD, N. Y. OEI~TIF'IP. ATE OF OOEIUPANO¥ THIS CERTIFIES that the building located at "I~1/~" Clls~'o~' 'A~re .......... Street ' 'xx ....... Lot No. t~ ...... Igrmth'old'i · lg;~f; .......... conforms substantially to the Applicati.on for Building Permit hereto]5ore filed in this office dated .......... t~a.l, eh .... tl.., 19.. 66pursuant to which Building Permit No.~0~l.~ 'Z" dated ............ l~areh. 'J.'l", 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 The certificate' is' issued t.o . '~h~' 'gehi~b' (owner,'1 tenant) o£ the aforesaid building. .Suffolk County Department of Health Appzoval .... 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? 3015 z Permission is hereby granted to: Building Inspector' Fee $.1.0~.00 ........... · Building Inspecto~ 1~ SUFFOLK COUNTY' DE?AEIMENT OF HEALTH Date BI_.dE. Permit No. TO WHOM IT MAY CONCEHN: The sewage disposal facilities for a structure located at (Give deed location) have been inspected by this Department and found to be satisfactory. 13istriot Engineer Distr~ct Enginee~ ' FOEM~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Examined .......... ~ .......... C~-x_- /.[~...., 19..~...~ Approved ........................... .~.?. ......... , 19....c.~. Permit No. ~'~J'~- Disapproved a/c ..... ~...~~ ....... ~ ....... ~- ..... ~-i ................................ ~ldi~~~:~ ..................................................... APPLIGATION FOR BUILDING PERMIT Application No...~....O....¢...~..~"~. ....... Date ........................ ~r. ch ....... Il ........... , 19..~0 ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or m 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 Regu at ons for the construction of buildings, additions or alterations or for removal or demolition, as herein described. The applicant agrees to comp y with oil applicable laws, ordinances, bui ding code and regulations. A ... Rei.1 ~.~..&..S~...Z.r~ ..................................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises ..x~r. tku~..~chi~b .................................................................................................................. 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 done. ,Map No.: ....~...~.%?..,~.~..e..~.....~,..~.~.~.. ..... Lot'No.: ..~.. .................... Street and Number ...Q.~.t.e.~..~.~t ............ S. QI;t.thD. Icl .......................................................................................... Municipality 2. State existing use and occupancy of premises and intended u~ and occupancy of proposed construction: a. Existing use and occupancy ........... .~.aa~.~..,~,~ ............................................................................................. b. Intended use and occupancy ....... o~.~..~a~....c].~/~,'Li~ ............................................................................ 3. Nat/Jre of work (check which applicable): New Building ..:.::ii~ ...... Addition .................. Alteration .................. ! Rep¢ir .................. Removal .................. Demolition .................. Other Work (Describe) ........................... [ ............. 4. Esti~ ~ated Cost ....... ~P~.QOD. ...................................... Fee ........ .1..0 ............................................................... i ............. (to be paid on filing this application) 5. If d veiling, number of dwelling units ............................ Number of dwelling units on each floor .............. ! ............. If g~rage, number of cars ........abe ................................................................................................................ i ............. 6. If usiness, commercial or mixed occupancy, specify nature and extent of each type of use .............. ~ ............. 7. Dim ;~nsions of existing structures, if any: Front Rear Depth Hei(ht Number of Stories ................... Dim ~nsions of same structure with alterations or additions: Front Rear ' Depth ................................ Height ....................... Z...Number of Stories ................................ 8. Dite. nsions of entire new construction: '.Front ........ ,...k,~-6 ............... Rear ....b¢9...-..6. ................ Depth .....2...~..[ .............. Hei~lht .................... Number of Stories'...ez~e ............................................................................................ ; .............. 9. S ze!of at Front .......'t2.0 .............. Rear ................. 3,2~) ........... Depth ....~..6..'~.../....~..'Z.9. ....... 10. Dat~- of Purchase ................. 1.9.68. ............................. Name of Former Owner .......................................... i .............. 11. Zon'e or use district in which premises are situated ........... ~ ......... ~t.:L~t; .................................................................... 12. Doc proposed construction violate any zoning law, ordinance or regulation? ............. ~. ........................... i .............. ]3. Nal ~e of Owner of premises ...~,~..~..~.t,~...~'.~.~$.~.lP......Address ............................................ Phone No. No, ne of Architect ...................................................... Address ............................................ Phone No .......: .............. Nal ~e of Contractor ...~.,...~RezL.'t~.~'..&..~toi'~$...];~e. Address ............. N~.t~¢&¢~.~e~. ......... Phone No .... ... ,; .............. PLOT DIAGRAM I.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names andi indicate whether in :erior or corner lot. STATE OF COUNTY above narr of said ow this applic that the ~ Sworn to Notary P~ , + ? NEW YORK, ~ e e )F: .....~'~t~£.o]J~ .......... ~ °'~' ............ · ~,...~f~l[~..~..~'.qD .............................. being duly sworn, deposes an~ says that he is the ~pplicant Name of individual signing application) i (Contractor, agent, corporate officer, etc.)J ~er or owners, and is duly authorized to perform or have performed the said work and to ~ke~ and file ~tion; that all statements contained in this application are true to the best of his knowledge and belief; and ,rk wJJl be performed in the manner set forth in the application filed therewith. flare me this ~ 4lc, ~~..~....~~ County , / / (Signature of applicant)