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Home My WebLink About3036-zFORM 1~0. 4 '/'OWlg' OF SOUTHOLD BUILDING DEPARTMENT ~,'OW~ CLERK'S OFFICE $OUTNOLD, N. Y. rt. ERTIF'II~AT£ OF OOOUF:ANOY No. ZaI~3 ~. ..... Date ................... ~T~te. · '8 ..... 19.6{;. THIS CERTIFIES that the building located at . t~/l~...Beael~ .Road .......... Street Map No .... X.~ ...... Block No .... ~ ....... Lot No. ~ ...... i~l~e~rl~00~.l;~..]~,.Y, ...... conforms substantially to the Applicati~on for Building Permit heretofore filed in this office dated ........... Apl'il" '¥ .... 19.66 pu.rsuant to which Building Permit No..~036.. ~ dated ......... Apl'II,.l.. II, ...... 19~., was issued, and conforms to all of the require- ments .of the .applicable provisi.ons of the law. The occupancy f, or which this certificate is issued is ... P.~. iv.ale..one · f~tmit, y. d.~e-~..ting ........................................ The certificate is issued t,o .... l~i'ch~cl"'P~l:etyt; ................. (owner, lessee or~en~ant)O ~I' ............. of the aforesaid building. .Suffolk County Department of Health Approval ......... l~l~t~ ........................... FOI~M NO. 2 TOWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLER[('$ OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3036 z Permission is hereby granted to: F~ay...,-,~z~:or.a....~Z.G....ff~Icn~r.d..'~.ol~%.L. ....................... ~at ~,..~,~,m .................................. to ...... :~.~$~d...~..s~dd ±t.o&~ ..czz ..,~c~.. ~,~...fl~J.~.~.J,2~ ...~,.~, ~J:~ g. ............................................ at premises located of ...~O~.f~..Z'~l~.~ .................................................................................................. ..................................................... g.~.e.e~r~r.~.~......~,.Z,. .............. ,-. ....... , ............................................... pursuant to application dated .............................. ~g~.]J, ....... ~ ........ , 19..~(~., and approved by the Building Inspector Fee ~ ,~ $.,.,.~.,0-0 .......... Building Inspector NO. 1 TOWN OF SOUTHOLD BUILDING DI~PARTMENT T~OWN CLERK'S OFFICE SOUTHOLD, H. ¥. Examined .....~......:.. ........... , 19 ~ Approved .......................... ~..~. ........... , 19.~.'. .... Permit NO ....... ~...0.....~.'...~......~ Application No ............................. APPLICATIO~ FOR BUILOI~4G PERMIT Date ApriZ 1+ , 19...6..6.. ..... 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 property must be drown 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with afl applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, en¢ineer, general contractor, electrician, plumber or builder. ....................................................... C. ontr.ac.tor. ................................................................................................................. Name of owner of premises ...... Richa~.d..:P.o;le.tt ............................................................................................................ 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.: ...... ~;:Y~ .......................... Lot No.: ~ ................. Street and N~mber .Be~o~..Read. r.~.~.se~.:pe.~:t, ........................................................ .....i ................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... d~e.~.~ ........................................................................................................... b. Intended use and occupancy ........ 8~..~.&~..~..aO~L¢&~ ...................................................................... 3. NatUre of work (check which applicable): New Building .................. Addition .xacx:~ .......Alteration .....i ............. Rep?ir .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estir~ated Cost ........ ~.~.Q{~.....lo~.~ .............................. Fee ...... .~[, ............................................................................... (to be paid On filing this application) 5. If dr/ailing, number of dwelling units ...ODe .................. Number of dwelling units on each floor ............................ I If g(~rage, number of cars ......... tCw'O .............................................................................................................................. 6. if b;usiness,~commercial or mixed occupancy, specify nature and extent of each type of use .............. ; ............. 7. Dimensions· of existing structures, if any: Front ............................ Rear ................................ Depth .................... i4h He t ........................ Number of Stories ................................................................................................................. D~mens~ons of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ 2.0 ................... Rear...2.0 .................... Depth ..J~6...i ............. Hei<, ht .................... Number of Stories ...... o~e ........................................................................................................ 9. Size of lot: Front ....... ..1..0...0. ............. Rear ........ ..~.Q ....................... Depth ..;~3.O ....................... 10. Dat~ of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zon' or use district in which premises are situated ............ I1~.11...~.'$.~'~ ...................................................................... ~ I 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ............ TJ,e ............................. ~ ............. 13. Nan ,* of Owner of premises .R::t~,~t~.d,.,I?ctl],e:l;,,,.,Address ...... O~.eezz~0~3zt..t ................ Phone No ....... .............. Narhe of Architect ...................................................... Address ............................................ Phone No ..................... Nan~e of Contractor .l~.,~..S.e. ra~..oz'.d ........................ Address ................ l~a.t;.~::],~;~o]~ ...... Phone No. / ! PLOT DIAGRAM : L.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lilnes. Give street and block number or description according to deed, and show street names andI indicate whether n ~rior or corner lot. ~-~ ' 0 6'o't STATE OF] NEW YOR,_K, 1 ,-,- ................. ;.: ......... [~.~Sr...~e~!n_~ ......................................... being duly sworn, deposes and says that he is the 3pplicant r~ame of individual signing application) above nan ed. He is the ......................................................................................................................................................... (Contractor, agent, corporate officer, etc.)' of said ow3er or owners, and is duly authorized to perform or have'performed the said work and to make and file this applic3tion; that all statements contained in this application are true to the best of his knowledge and belief; and that the w,~rk will be performed in the manner set forth in the application filed there~th. Sworn to b'efore~_ me this I/1 ~ ~/ ~ / ' No 52-0344963 Suffol,~ County . /