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HomeMy WebLinkAbout3312-z~O]g,~ 1~0. 4 TOWN OF SOUTHOLD BUILDIN(~ DEPARTMENT v/OWN CL~RK'S OFFICE SOUTHOLD, N. Y. No. ~,. ~66.~ ..... Date ............. Febura.~y- · .16 ·., 19.67. THIS CERTIFIES that the building located at .. 'N/~ '0t'~l~;:t'~l' ~'e ......... Street Map No. ]~.,~[~., .... Block No. XX~ ........ Lot No.. ~X~C. · 'Fi'Shex'~' '~'~te~d-~- 'N'o-Y~' conforms substa,ltially t.o the Applicati. on for Building Permit heretof~o~e filed in this office dated ......... 1~O¥., ...... ~.., 19.66. pursuant to which Building Permit No.~. 'Z" dated .......... I~(~V ...... ~{..., 1966., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The ~o.ccupancy for which this certificate is issued is . ~ri.~a~e. one. -fi. amity. ~lwetl:t-ng ........................................ The certificate is issued t.o .l~lc~l'.gt~. BtlCklleX' ..... ~et' ........................ (owner, lessee or tenant) of the aforesaid building. ~uffolk County Department of Health Approval . .]~O,~.~t~O .~q~,'l;el, .O,,K, ................. 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? 3312 Z Permission is hereby granted to: .... ........... · .~,~e.=a...Z~l,a~ct ................................... to . .b:l,t,1.].d,.. =,e]¢.. cxl3e., t' n m :L].~.. A,ara;L].~j:~ .................................................................................. at premises located at ...JJ//l~,..~l~_-~-rs..]:...AVe .................................................................................... ..................................... F~l, she ~'.8..~ s3~az~l,,...ti,:~ o ........................................................................... pursuan¢ to application dated ....................... ~D~,e .......... 'lbx ............. , 1~)...., and approved by the Building Inspector. Fee $..~,Q.e,QO .......... Building Inspector FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Date Apphcahon No .......................... INSTRUCTIONS o This opplicobon must be completely filled m by typewriter or m ink ond submitted m duphcote to the Build~nt Inspector, b Plot plan showing location of lot and of buddings on premises, relationship to odloming premtses or pubhc streets o, areas, and giwng a detailed description of layout of property must be drawn on the diagram which ~s part of th~s opphcohon c. The work covered by th,s apphcat~on may not be commenced before issuance of Building Permit. 6. Upon approval of this application, the Building Inspector will ~ssue o Budding Perm;t to the applicant Suck permit shall be kept on the premises avadable for respect, on throughout the progress of the work. e No building shall be occupied or used m whole or in pa rt for any purpose whatever until o Certificate of Occupanc? shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuan.c~ of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York,/d'r~ other apphcable Laws, Ordinances or Regulations, for the construct,on of buddings, oddit,ons or o lterat,ons, or fo~o~ or ~,t~, as herein described The apphcont agrees to comply w~th all ~pplicable la~s, or~ances and r~g~ //Z~ // Sto~vhether a/~plicant_L,s o, wner, lessee, agent, orch,tect, eng,neer, general contractor, electrician, plumber or builder. ..... ..... ........................ Nome of ov/~ner of premises .....~...4~/..~.C<~..~,,......&.(../~..~. '~..~ ........................................................... If apph//,V~.c~/C~/ffit/s,gngt~ure of duly authorized off,cer ........ ..................... r~ -"(N~rn¢'-'6/~ t,tle of corporate officer) 1. Location of land on which~/"~/-.pr°p°sed'w°rk will be done Ma~ No ........... , ..... ~ ....... ~ ...... , .. Lot No ............... Street and Number ....6/./"...C..(:.~./..'/...~.........~..h.c-'~.~?'~...~..~¢.7~'.....:.~.......~...~..~.~....~...~.~Z.t.~:..~r ............. Mumopality 2 State existing use and occupancy of prem,ses ,aC ,Z_.~use and occupancy of proposed construct,on . 7'-' a. Ex~stmg use and occupancy .... ~ ....... /~. ........ /., .... _ ......., ................................. ~tended use and occupancy .... /~..../~/',,.~..../..~.~...~~ .............................................. b 3. Nature of work (check which applicable)' New Building ................. Addition .............. AIterqt~on .................. Repair ............ .~,~. R~emoval ........... Demolition ............ O.~_ther Work (Describe) ......... : .......... 4. Estimated Cost~..2.~../ ......... ~.~.0.~ ........................................ Fee /~.~.(to .......................................................... be pa,d on filing this apphcation) 5 If dwelling, number of dwelling unit~. / ........... Number of dwelhng units on each floor ........................ If garage, number of cars ............~.~.J/~.. ......................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................. 7 Dimensions of ex~sting structures, if any' Front /~.~../?...~.... Rear ...................... Depth .......................... Height ............................ Number of Stones ............................................................................................ Dtmensions of same structure with alterations or addihons Front . ../~;~..~ ....... Rear ............................. Depth ............................ Height ......................... ..._.hJumber of Stones ........................................ 8. D, mens,onsofent,r, e newconstruct,on Front...~/'~.~.,.~, ............ Rear ....~...¢4X~.~. ....... Depth .....Z~..~ .... Height.../~, .~,.~ .......... Nu_rober of Stories .... Z ..~..x..~. .............. 9. Size of lot' Front ./.~..O .~.,.. ., Rear /.~.A~... Depth 2 ...~.......~.~_'. 10 Date of Purchase ..... i.~.~.'.'~?.,.'~,'ZZ . ..[i.i ..i. '.'N~f Formel ~; 'i~./'.~ "~i~ ' ./...~. ~...~........~//..9'7...~/. 11 Zone or use d~strict m which premises are s~tuated. . .,/~...~..~.: ................................................................. 12 Does proposed construchon woJat? ,any zogir~ aw,, ord nonce or regular om? .... ..~...~. 13 Name of Owner of premises~//:,.....~....~.J../.(~...~,~ ...... ~j,~j../~/ ....................... ;;~..z'- ""'"'" "'" C././..~....""phone'No ~;~.' ~/~,~ d d r e s s Name of Arch,tect ./~.~.~-f/.~.~,,...~j~./~ ~.'Z "';~' z:~-~ "'z"' ":"- '~'~"~/"Y '"'/'~ ri9~ P_ one No Name of Contractor/~.~ PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~sting or proposed, and indicate all set-back d~mensions fror property hnes Give street block numbers or description according to deed, and show street names and indicat whether ~nterior or corner i STATE OF NE'~.~Y~qK., COUN'h-Y, 9F ~-~. ~ t ......... ~..~1;.~> ~/.~ ............" .............. be,ng duly sworn, deposes and says that he ,s the applicat (Name of ,n~vidu~si~ng ~l,catlon) above named He ,s the ...~/~~ .......... (Contractor, agent, corporate officer, etc ) of satd owner or owners, and this apphcat~on; that all statements contained m th~s apphcat~on~e t~.t~est of h~s knowledge~ and belie 6nd that the work will be performed in the manner set forth m ~ica~o~le~therewith. Sworn to before me thisk '~ doyof ~~~ ~t~~CC ~~~~'~re ~of ~ ~o. 52-0028880 ' ' ................................ : ................................