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Home My WebLink About3029-z~ORM ~0.4 TOWN OF SOUTHOLD BUILDING DEPAI~TMENT 'I*'OWN CLERK'S OFFICE SOUTHOLD, N. Y, r. EETIFIOATE OF [I[.II]LIPANOY No .... z., ~4.3.e,. Date ............... .a.~..n.c...2 ......... , XO..6.6. THIS CERTIFIES that the building located at ........ .Sm&th. l:}l¢~.v.e ........ Street Goose Map i'4o..l~l~.t;t~.e$.. Block No.. ~ ..... Lot No..115. ......... $o~th~ld,. conforms substantially to the App]icafi,on for Building Permit heretofore flied in ~his office dated ....... ~. ~.~ .... ~9~. pursuan~ to which Bufldin~ Permi~ da~ed ....... ~ .~ ........ 19.~., was ~ssued, and conforms to ali of the require- ments ~of ~he .applicable provisions of the ~aw. The .occupancy for which th~s certificate issued is ...... ~.~. 2~. one. ~ly..~ell~ng ................................ The certificate is issued ~o ...~l~m B..$~..~O~ .C~S. Holmes.,..~ne~.. (owner, lessee or tenant) of the afore.said building. Suffolk County Department of Health Appr,oval ......................................... FORI~[ NO. 2 TOWN OF SOUTNOLD 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? 3029 Z Date ......................... [&~:i~eh ....... '26 ........... , 19..(~. Permission is hereby granted to: ~ra....~ ~.. 8~.£ ¢.h...a/.~.. ~a~.~ ea.. ~o.~tae~ ........... .......... ga~tt, ho.~d .................................................. to ~ui.Z.¢]...a~ · · a~tct.~.~i.o~...e~ · · 8:n.. e×:k,~ ~i.n~ ..~e~:~iza~ ......................................................... at premises located at ....~.~.~'~-'...1)~-~Ve'~f~tt'¢'h .............................................................................. .......................... · Let...l.~k~T.....¢~ ~o s~.. '~.le~ky'"' Do~t~c ~ti ~'" '?,~;; '~2 ;; ................................ '.'""i ....... pursuant to application dated ............................... IP&]3~......],O. .......... lg($~..., and approved by the Building Inspector Fee $...~..00. ........... FOEH NO. 1 TO~VN OF $OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo Examined ...... Approved ........................................ , 19 ........ Permit No ................................. Disopproved o/c .............................................................................................. ........................ (Buildino InspectS) Application No....~....~....~....~. ........... APPLICATION FOR BUILDING PERMIT Dote ....................... 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 o 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 .o 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. /ff .... ,? '--7 ........................ (Signature of applicant, or name, if a corporation) (Address of applicant) State whg~er 9pplican~_is ow.nerg_~see, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem scs ..... ~:...~~..'~... .......................................................................... If applicant is a corporate, signature of duly authoFized officer. 1. Location of land on which proposed wor~i,I be~do,,ne. Map,~o~--.....~....~-.~Lo, No: ../,Z..J], ........ Street and Number ..................... ~~ ...................... M6nicipality ............ 2. State existing use and occupancy of ~ and,intended use and occupancy of proposed construction: a. Existing use and occupancy ........... 4~....~... ..................................................................................................... b. Intended use and occupancy ........ .fi~..(~ ...................................................................................................... Dirt Dep 8. Dirt Hek, 10. 11. .I No,lure of work (check which applicable): New Building .................. Addition .................. Alteration ...., ............. / Repj:ir .................... Removal .................... Demolition .................... Other Work (Describe) ........................ .............. Esti?ated Cost ............. .,~...., .)~:.. ................. ; ................. Fee ....~..........-~. ........................................................... ; .............. (to be paid on filing this application) : If dLwelling, number of dwelling units ............ Number of dwelling units on each i ............ floor ............................ If gl~rage, number of cars ............................................................................................................................. ~ ............. If I:}usiness, commercial or mixed occupancy, specify nature and extent of each type of use .................. i ............. / Dimensions of existing structures, if any: Front ...... .?....~.. ............ Rear ...... ..~.....~.. ........... Depth ..~.~....i ............. Height ....... /.~...'~. ............ Number of Stories ............ ~ ................................................................................ i ............. ensions af same structure with alterations or additions: Front .......... ..Z~....~. ............... Rear .....-~.....~-).. ...... i ............. :h .....~-.~? .................... Height .............................. Number of Stories .........../... ........................ ensions of entire new construction: Front ..... ........................ Rear ............................ Depth ............................ ht ............................ Number of Stories ............................ Size of lot: Front ....... ~../~. ............. Rear ....... ~...~ ............ Depth ..., .~.....~.....~. ................. / Zone or use district 'n which premises ore s'tuated ...... ~4~. ,~.....~ .......................................................... ,~/_, L ............. proposed construction violate any zoninfl Iow, ordinance pr r, egulalion? ..... /.V....~.. .................................... ~e of Architect Address Phone No. PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensibns from res. Give street or _blnck n,,mh~rs o~- d~erinfinn ncrnr4ipg tn rl~rl .g.g~how stree_t pa~e~ andl indicate erior or corner lot. ' 12.' Doe 13. Nar Nar Nan L.ocoh property li~ whether ini STATE OFINEW~~L.,' ~ S S ' , ~ bern dui sworn ~..- ..~......~ ' g y , deposes and soys that he is the pplicant (~Jame of m&v,duol s,gn,~ oppli.ca/~ion) ,9 above na~ed. He is the .................~.~.~ ..................................................................................... : ............. / (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make land file this application; that all statements contained in this application are true to the best of his knowledge anti belief; and t~at t~e work will be performed in the manner set forth in the application filed therewith. Sworn to~,before me this ~~-- / * ~ H~ .............. ........ .......... ----, ..,. / ..... ........ Notary Pu~lic,~~,.,~...,~ogo~y,,,~ (S,gnoture of app~cant) j Comm,ssluil Expires Nlsrch 30, tg~ ? / u~ -