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Home My WebLink About3042-z~ORI~I ~0. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE gOUTHOLD, N. Y. 5EI~TIF'ISATE UV UI~.fiHPANI~.Y No. g.2672 .... Date ................ l~a~h. · · · '~'3 .... 19.67 THIS CERTIFIES that the building located at 'I~'//~'' i~i/~ill 'Road ............ Street Map No... X~ ....... Block No ..... ~ ..... Lot No...~e~ .... ~i;t;l,~;~l~k~. -N,~., ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... AI~t~"~-'' '7 .... 19. ~(~ pursu'ant to which Building Permit No. ~0~2' ~' dated ............ ./tl~...7. ., 19.6~., was issued, and conforms to all of the require- ments ,of ~he applicable pro¥is~ons of the law. The .occupancy f~or which this certificate is issued is . ~I15iI1/~ .~)l~i~.d. iltg · - (.Lal~- .Of'f. ie./~ ) ..................................... The certificate is issued to . .~i].].iatll. ~iflkha~ ...... /)t~/~, ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ~...e..~[ ............................. Building Inspector FOP~M NO. 2 TOWN OF SOOTlqOLO BUILDIHG DEPARTMElqT TOWH CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDllqG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3042 Z Date ............................... A.pP.I.t ....... '7 ....... , 19.66_ pursuant to application ~ated ....................... : ............. ~,P~.l~.....~ .... Permission is hereby granted to: ...: ............. ~t.¢t ~,.uek ......................................... to ....Ruit.~...an. -ad, di-~i~)n.. ~ ..a~a.. t~xi.~ ~.i.ng-..busi~-~s...btt~t~}i~g ...................... : ......... at premises located at ...M,Z.[L....~$~..P,~a~.~. ............................................ i ......................................... .................................. ~a.~ ~i.J:uek.~..:. · .tq.~ .:Z~ ........................... : ............... : ..................... .......... ~ ............................................................ L.~ ...... ~ ........ ~ .......... : ................... ; ....... ~ ................................ 19.~l~., and approved by the Building Inspector FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ PermH- No .............................. Disapproved a/c ~.../~...Z~.~.~:~ .~4~...~..~'''~ ..... ..................... ......................... APPLICATION FOR BUILDING PERMIT Date ..~..~ ........................ I~.. INSTRUCTIONS f? · 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 a detailed description of layout of property must be drawn on the diagram which is part of this applica- tion. 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 pa rt for a~y purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS H.EREBY 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 opplicable Laws, Ordinances or Regulations for the construction of buildings additions alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances an/d regulations. .......... . ... ....... ( 'g pplicont, or name, if a corporation) ................... /.z..4c..zzx .................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................................................................. If applic,~nt is o. corporate, signature of duly authorized officer. ,/ . .......... (Name and t~tIe~~) 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No.: ...................... Street and Number .................................................................................. ,:~{;~.....~...~../.' ..~..~4~464.'~....~.. '~.~..'. ............... Municipality 2. State existing use and occupancy of prerp~ses and int,e, nded use and occupancy of proposed construction. a. Existing use and occupancy ......................................................................................................... use b. Intended and occupancy ................... ,-~...-.~.....2~..~-., ...................................................................... 4. 5. 6. 10. 12. 13. property lines. Give street and block numbers or description .according to deed, and show street names and' whether ir~terior or corner lot. ..5'"~o '- ~" NatUre of work (check which applicable): New' Building .................... Addition. ....... J.......... Alteration ...~....~i, ........ | Repc~ r R oval ........ Demol t on Other Work (Describe) i (to be paid on filing this application) If dwelhng, number of dwelling units ................................ Number of dwelling units on each floor If gc~rage, number of cars .......................................................................................................................... i .............. If bL~siness, commercial or m,xed occupa,ncy, spec,fy nature .and extent of each type of use Z~.'.'~.~.'~ .../.~..,~.~... Dimensions of existing structures, if any: Front ..~..~ ....... ~?. ....... Rear .~..~.....~.. .......... Depth ............................. Heig'ht ............................ Number of Stories ~ ../2/'.x~. ................................................ Dimensions of same structure with alterations or additions: Front ~/ ~ ............................... Reor~~ ............. Dep(h ............. Height ................................ Number of Stories ...~'~..~ ............. D,m~nslons of ent,re new construchon Front ~--~ff~ .'.-~.~.. ....... Rear ,¢~ .'-'.~. Death X~,42 ~,-J Size of lot: Front .~...~..?.~.. .......... Rear .....~.....~....~.....~..... Depth ......~..L..~_..y.....&?. ....... Zon~J or use district in which premises are situated ...................................................................................... i .............. Does; proposedownerCOnstructiOnof viql.at, e any zoning low, OrdAddressnance ~ Nor~e .,I PLOT DIAGRAM Locoie clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from indicate STATE OF!NEW YJ:2R, ,, z/ ) S S COUNTY OF ../.-~.4~/~.?'.~.~.:.....) .. ....... ................ being duly sworn, deposes and soys that he is the a'pp cant above named. He is the ................ ~.~/~ /Z~... (~,.'~.~.~ZC.~(4?~ .................. , ............. ~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or h~ve performed the said work and to make and Ifi}e this applicationj that ail statements contained in this application are true to the best of his knowledge and belief; and that the w~rk w [I be performed m the manner set forth m the apphcahon filed therewith. Sworn~o h~fore me th s - '-~1 D-O,B~IE~ .. ~ ......... ~. , HE~'t' ' ......... . ~ ............ ~ ........... ~,~b.., ~ 7 0