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Home My WebLink About3045-zFORM 1'¢0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'l'OW]~l CLERK'S OFFICE SOUTHOLD, N. Y. I~ERTIF'IEIATE rIF FligEIU~ANIgY No. Z. 2646.. · Date .......... THiS CERTIFIES that the building located at .~9. ~i~. ~d ....... Streei P ~°C~ub' '~Op~ ..... ~ ...... Lot No ...... 4 ........ Cu~ch~ue .......... conforms substantially ~o the Applicati,on for Building Permit heretofore filed in this office dated ........ April .7 ......... 1~6.. pursuant to which Building Permit No.3~5. ~.. dated ........ April. ~ ........ , 19. ~, was issued, and conforms to all of the require- merits .of the .applicable provisi.ons of the law. Tim .occupancy got which this certificate is issued is ...addition..to..on~. ~iLy. ~ellin9 ................................... The certificate is issued t,o ,. itatt .~. ~I~I~t ................................ (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......................................... FOP~M NO. 2 TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, 1'4. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3045 z Date ..................... A{0,~.i.l ....... ~ ................. , ] 9...~ Permission is hereby granted to: RJ, eha~d...~t.~g./~z,t' ....................... : .......... ~ ....... ......... [@~...~e~t~r~,t.,.¢.t...,.~rde~..e~.~¥ at premises located at ..... ~O.~..~,..,.}}a~8¢~...]Bo~.I~,..~...~-]L-..~ ....................................................... ................................ Nas.~au..2**o~n.~...~ad~.....C~¢~ho.~ue ........................................................... pursuant to application dated ................................ A~3::lc::l], ....... .~. ....... 19.(~.., and approved by the Building Inspector Fee $....~e.QO. .......... ....... · " '"" ........... B., g nsp eta \. '"'i¥;;'"i-'";'-%'''' ..................... FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............ Approved .................... .u..? ................ , 19 ........ Permit No.................'~' ~/~,Z---.... Disapproved a/c ............... ii' ............ ................................. ................................. Application No. ~ 0 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 a detailed description of layo0t of property must be drawn on the diagrar~ 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 f~>r~ removal or demolition,,~s herein described. The applicant agrees to comply with oil applicable lows, ordinances, bui~,~g c~ode c~nd r~otions./~/ /, State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder. Name of owner of premises .................................................................................................................................................... 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.: ~)o~ ¢~-u~ ~,~. I~a. /~f ~..~-., .................... ~ .............. No.: .................... Street and Number ................................................................................ .j ........ ~L';~'l'iT~' ...................................... 2. State existing use and occupancy of premises and in~ended use and occupancy of proposed construction: o. Existing use and occupancy ....... ~'t~.~...~.~/.~.~......~..~[~f~....~.',~.~ ............................................................... b, Intended use and occupancy ............................................................................... t ................................................ 12. Doe 13. Nar Nar Nar 3. Nat. re of work (check which applicable): New Building .................. Addition..................~'~' Alteration ' Repair .................. Removal .................. Demolitian .................. Other Work (Describe) ........................... . ............. ' _%o~O ~ 4. Estin~ated Cost ........ .~ ........ t ......................................... ~ee .......................................................................................... i (to be paid on filing this application) 5. If d~veHing, number of dwelling units......... .......... ~ .........Number of dwelling units on each floor If g~rage, number of cars ................................................................................................................................. 6. If ~usiness, commercial or mixed occupancy, specify nature and extent of ~each type of use .............. i ............. 7. D m.'ens ohs of existing structures, if any: Front ...... t~.~ ................ Rear .....~..~ ....................... Depth ..~.%/. ............. Height........................'~' o t Number of Stories ..... ' .'~',. .......................................................................................... : ............. · .¢£ ' ~,~ D,m?s OhS oI same structure with alteratiogs or additions: Front .................................... Rear .....~.'; ....... I ............. Dep!h ....~..'~ ....................... Height ........ .~?. ................ Number of Star.es ..,..F.~%~..").~t.~.".~.....! 8. Dimlensions of entire new construction: Front .......... ~2...~ ................... Rear ........ ~P..'. .............. Depth $ " ................... 1 e~ . Number of Stories .......... ~ ............................................................................................................ Hee~ ht~ ,% ~ '~, 9. Siz_. of lot: Front ~ ~ ¢ ~ Rear °" ~ ................................... ~ ............................ Depth .............. : ................. 10. Dat~ of Purchase ........................................................ Name of Former Owner .......................................... .............. 11. Zone or use district in which premises are situated ..................................................................................................... proposed construction violate any~zoning law, ordinance or regulation? ,e of Owner of premises ~.:f,!~..~.k.b...~:...CC..?.~..c..~.~?...Address ....... .~.*.fi*.%,..E,f.~ ............... Phone No. ~ ...................................................... Address ............................................ Phone No ........ .............. ~e of Architect .... ~e of Contractor .................................................... Address ............................................ Phone No ..................... Locat, property Ii whether PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensipns from ~es. Give street and block number or description according to deed, and show street names andi indicate erior or corner lot. STATE OF:i NEW YORK, t c e COUNTY fOE ..... ~£,f~lk .......... ~ '~"~' ................. [..~..&..~.~.~-.[.d......J.f.,.....B.!~gX.i%,¢. ................................ being duly sworn, deposes and says that he is the bpplicant I(Name of individual sig~ above naroed. He is the .......................................................................................................................................... ~ .............. (Contractor, agent, corporate officer, etc.): of said o~ner or owners, and is duly authorized to perform or have pe~rformed the said work and to make and file this applic~ation; that all statements contained in this application ar%tee to the best of his knowledge and belief; and that ~l~e wbrk will be performed in the manner set forth in the applicaJJ¢ filed therew~ /¢ : Sworn to b.'efore me this //.' ~ [, ///~ : I~lo(~ry Public, State ef New Vor~ Residing In Suffolk Couat¥ No, 52-8641100