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Home My WebLink About3051-zI~ORM l~O. 4, TOWN OF SOUTHOLD BUILDING DEPAI~Ti~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. ~¥. r:ERTIFIP. ATE OF' EIEll2UIZANEI¥ THIS CERTIFIES that the building locate~ at ~.~,~.W.~ .O.f.i'./~],piri~. AV~ .... Street Map No ..... Y~ ..... Block No...Y~X ....... L~)t No..F-ishers..Is~ar~d... N.,Y, ........ conforms substantially to the Applicati~on for Building Permit heretofore flied in this office dated .............. A~r~]-...~.~.1966. pursuant to which Building Permit No.. '~0~'~ 'Z dated .......... A:pri.~ .... 1~.., 19.~6, was issued, and conforms to all of the require- ments .of the applicable provisi.ons of the law. The .occupancy ~or which this certificate is of the afore.said building. .Suffolk County Department of Health Approval ...... ])~r~.i. lq§ ......... , :. .............. " Building Inspector FOI~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~C:E SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3051 z Permission is hereby granted to: ............... ~p~..kt45 ....................................... Fisher ~ Island to ~2~,ld new one zam~].g at premises located at A[~iBo ~shers Island p~rSuoDt to opp]~cofio~ dote~ ........................... ~. ...... Building Inspector Fee S....I...O..'...O..O.. ........ "'"'""'""'"'""'"'"'"'"'"'"'"'"'I'"'"'"'"'"""'Building Inspector ,..qv Application No ............................. APPLICATION FOR BUILDING PERMIT Date ...././.....:/..~... ........... i .................. , ]9.., ,~..~... .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot p}on 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 bedrawn on thediogrom 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 tF~is 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 whate~er until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the/i~ss~n~e Ofza Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New,/(~ o~,~6d o/~er,~p,~ic,g~le Laws, Ordinances or P, egulations, for the construction of buildings, additions or alterationsy/gf~/~-,fo~?r~fal ,,~./~m,~tion, as herein described. The applicant agrees to comply with all applicable laws, ordinance~ '9;~7'~r~d~k~rfons//'~' // .-i ........... ': ......... -.::.....: .......................................... , (Signature of a~;~li,~nt, or name, if a cor~poration) (Ad~ress of applicant) State whether opflicant is o,~er, I~s~ee, agent, architect, engineer, general controctor, electrician, plumber or builder. ........................................................... Name of/<~ner of prem~es ..2.~.~.~ ....... .~..~.Q.~.~.....:....~..I'..LI':.~......~..~.~.~..~ ................... If~~~op a is c rte, sig~ture~ of duly authorized officer'. "' i~';¢' corp~7;~;";'f~;'~ ................... I. kecat[on of Iond on which proposed work will beOone. Mop~o: ....................... . .................... ~ot ~o: .................... ........ ...................... Municipality 2 Store existin~ use ond occuponcy o~ premises ~nd i ntended~use ond occuponc~ of proposed coCstruct[on: o. ~xistinO u~e ond Occupor~V .......... ~-~ ............... ~.~ ...... ~ ................... ................ : ................................... b. lntended,useond oceupo~c~- ~ }~ 3. NatHre of work (check which applicable): New Building .................. Addition .................. Alteration .................. Rep6ir .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Esti ~ated Cost ....../2/..~....~,.,~ ................................... Fee ........... ./.1~..,.....~... .................................................. i ............. (to be paid on filing this application) : 5. If d~telling, number of dwelling units ........... / .......... ~.....Nun~ber of dwelling unlts,o/~ each floor ..... L..".'.Z .......... Ifge rage, number of cars ......../.....~...~q..~..../......~-~c~.~Ym....//~4i.//4'x~:C.m ...... ~...~.../.../.~7./.T..,./4x/....h...~.....;~. 6. If bJsiness, commercial or mixed occupancy, specify nature.and extent of each type of use 7. Dim~msions of existing structures, if any: Front ........ :..~... ............ Rear ........... ~:'t ....... Depth ........."'-~. ....... ............. Hei ht J Number of Stories ~ DirrensJons of same structure with alterations or additions: Front ......... ~ .................. Rear Del:th ............................ Height ............ ~ ............... Number of Stories ........................................ 8. Dirr ensionsofentire n~wconstruction: Front ........... ff...~.. .............. Rear ........ ..~...?.. ........... Depth .....,¢~..,.~" ........... 9. Siz, of Io,: Fron~/'Z'..°~:..../..'./'~.,... .......... Rear~..~.~.~..~ ........... Deptl~//~t.,~C3..(,~ .......... .. ......... --- __; 10. Dar, i, of Purchase .../[J.~..U.. ....... ./.~.~...~.... ..................... Name ~z):~/ Former Owner ,.~...~.&.'-/.......~.~..~;.cT../?.C/.....~,.? .,~7.~c. 11. Zon~ or use district in which premises are situated ......... /ff...~.,,~ ........................................................................ 12. Does proposed construchon v~olate any zomna taw, ordinance Or regulohon ........ ~.~. ........................................ 13. Nar~e of Owner of premises ....~..t.[ll.(~,~ ........ ,..~..,...'.~.~ddress...~Z,¢:/.~.~$...,~/../~./.~.~.. Phone No.~.~...~.-.:~...~...~.(J Na~e of Architect ..~..~/.~..~ ~'~. .... Address ...../J~/~.44J...~'t:..~....~.~...~.... Phone No ....... i ............. PLOT DIAGRAM L_ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-bock dimensibns from property lihes. Give street and block numbers or description according to deed, and show street names andl indicate whether in~'erior or corner lot. / STATE Of NE'~ YQP~I<,, b~ ) ~ ~ Il ~ ~ , , ~"~'"'-'?[" \~~ , [~O~.f.~....~.~..~'O':~..:.~.y...~.~., ................................. beingdulysworn, deposesandsaysthotheistheqpplicant ........ (qame of individ~al~gning~applic~tion) i above na~ed. He is the ....~.~.c.~~ ....................................................................................................... ~ ............. (Contractor~ agent, corporate officer, etc.) of said owper or owners, and is duly authorized to perform or have~rfo~med ,the said work and to make ~and file this applicDtion; that all statements contained in this applicatioq ~t~ to/ ~st~f his knowledge and belief; and that the work will be performed in the manner set forth in t~p~ati~ ~th~ewith. S worr, to b~fore me this ~7~~ ~ Z ' . ~ M~ ~ ~o.~-oo:s~o ...~x~_~_.:~ ~_;..r...~.~,~.....: ................................ Notary Public,~...,f~~.C~un~ ....... County ~(~ ~ature of appffhm~t) ~