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 ' ' ................................ : ................................