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Home My WebLink About3034-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. I'I.I~RTI£,II~ATI~ JIF r~I~UI~AN~¥ THIS CERTIFIES that the building located at . .l~.Y~.. ~1;'~3.~. &.V.~ ........... Street Map No.l~l~.,l~lllt.. Block No .... 1~ ...... Lot No..~.~..~..6.6... ¢.~.1;.¢.~.Og1~.~..~.,~ .... conforms substantially Lo the Applicati,on for Building Permit heretofore flied in this office dated ........... }laI'Oll ....~, 19. (~6 pursuant to which Building Permit No..~{)3t~. ~ dated ............. .[~la~.~h...~. 19..~ was issued, and conforms to all of the require- me.nts .o~ the .applicable provisions of the law. The .occupancy ~or which this certificate is issued is .. l~.~'t~t~l~O..0~0. ~llt;[~r. c~¢o~lil~lg ......................................... The certificate is issued t,o . .I~'l~k. ~lt~$h .............. O}~iOX'. ........ ~ .............. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ....... ~.~..]~.* ........................... FOP~/ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S Ol:i:~CE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 303~l Z Date ...................... :~%~e~.....~, ................ , Permission is hereby granted to: ~a.~.~.u~ ..................................................... ......... .T.~.ae~...~ve ................................................ ................. (~.ue~ahegt,~e ......................................... to..]~xi.l~l...~r,..aero1. ~t-~i~n...o~.. a~" ~:~'~ t~g'"cl~e,~t/[ng ........................................................ at premises located at ...,l.~.~...6~...~..~t~.....~,.l~,...~,rl~.~..~..~, ................................................. ............................ ~'~" ~'~k'1' '-,~'~'a '~ '~""' .g~¢ehe~ue ~.-... ~.g.,. ............................................................... pursuant to application dated ............................... }¢~eh ....... '~'~.- ...... 19..~., and approved by the Building Inspector Fee $.. ~.,.O.Q ............ FOI~M~ NO. 1 ?OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ........ , Approved ........................................ ~ 19 ......~ermit ~o ............................. ~isapproved o/c ........~ ............................................................................ ....................... ....................................... (Suildin~ I~spector) Application No...~..~..~..~.~.. .......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application' must be completely filled in by typewriter or in ink and submilted 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 port 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 ~o 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, ordinang,~es, building code .and regulations. (Signature///applicant, or name, if a corporation) T~.a~.. ~u~ ...,...C.u t~ o.gu~ ,... Ne.~....~ork ...................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner af premises , ,.,.F,~',~,~,.~,:~,9.~ ................................................. 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.:M..~..S........H...a..n...d.,.....S..e...c.:.....2. Lot No.: ...6...5.....&....6...6. ..... Street and Number ........... T~.~.g~...A...v..e..,.~...Cutcho.gu~.,...l~f~.~....Y. Qr~ ............................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... .O...n..e.....f...a..m..z,'..1.y.....d..w..e. 1..1...i..n.~ .............................................................................. b. Intended use and occupancy ..... .O.u.~...£m, ia4,1y...d.~.~,14,~g...~4,~l..g~,~.~,g.~ ................................................. 3. Natt~re of work (check which applicable): New Bu ding .................. Addition .................. Alteration .................. Repc~ir .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estir~atedl Cost ...... ~[~IIIIB~. "'~2'00~"~ ............. Fee ........... i~l;~;i~..~.~.,¥i.l.i.~.~..~.i.~..~ii~ii~r~i...,. ............. S. If d,lwelHng, number of dwelling units ............................ Number of dwelling units on each floor .............. i ............. If g~roge, number of cars ............................................................. i . . 6. If b;usiness, commercial or mixed occupancy, specify nature and extent of each type of use .............. ~ ............. 7. Dimensions of existing structures, Jf any: Front ...... .~..,.i ............. Rear ........ ~1'" ................. Depth "26'"'! ......... Height ........................ Number of Stories ........ i~i~' .................................................................................... i ............. Dimensions of same structure with alterations or additions: Front ....... ~,. ...................... Rear ...~;~.r..,I ............. Dep!h ......~4~ ................... Height ............................ Number of Stories ..........OWe ............... 8. Dim~ensions of entire new construction: Front .................................... Rear ............................ Depth .......... r ............. He t .................... Number of Stories ....................................................................................................... , .............. 9. S'ze!of lot: Front '"'ZOO" ............... Rear ............ 1.OiDV .............. Depth ...3..~., .................... 10. Dar of Purchase ""~i~iJ["l'~.~l~ ...........................Name of Former Owner : 11. Zon , or use district in which premises are situated ....#.~..~(~ilj,~.i;~i~..[ ............................................... i ............. 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? .............. .~....O, ......................... i ............ 13. Nar ~e of Owner of prem!ses ...~ .......~ ............. , ............ Address ...~ ....... ~ ................ : ........ ~.. I~hone No .......: .............. Nar ~e of Architect ...................................................... Address ............................................ Phone No. Nar ~e of Co~traetor ........~ .................................. Address ............................................ Phone No ..................... ~ PLOT DIAGRAM Locet~clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property li~es. Give street and block number or description according to deed, and show street names andj indicate whether in~ eHor or corner lot. STATE OFI NEW YORK, 't c c COUNTY [OF '~g~l~'~O~l~ .............. ?"~' ,-/c. A t;? · .......... . OC~ being sworn .......... ~ .............. ~/,¢:~ .................... duly deposes and says that he is the ~pplicant obove nonied. He is the ......................................................................................................................................................... i (Contractor, agent, corporate officer, etc.)j of said owner or owners, and is duly authorized to perform or have performed the said work and to makej end file th s app c'at on; that a statements contained n this appl cat on are true to the best of h s Cnowledge and be of; and that the wgrk will be performed in the manner set forth in the apphcahon filed therewith. Sworn to b~fore me this ~/~ . day of '~' .)~.~., ]9 ~ ~ --' · ~ / / '~ ' ......... ,'"; ............. 7' - .....'. ........ Notary Public~.}.::)~......~.,..Z~,,~County (S~oture of applicant)~ -- ~ ' U -- ~o. 52-3233~20 S~f[o[ll C~d~y I ~rm [xplre~ Maroh 30, 19~