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Home My WebLink About3052-z'FOWN OF SOUTHOLD BUILDING. DEPARTMENT ~l~'OWl~' CLERK'S OFFICE SOUTHOLD. N. Y. O~'~T~F~O~T~- OF O00U~ANOY No. ~ 2587 Date 0~tobe;r 27 19. 66 THIS CERTIFIES that the building located at ~.l~P~l~..~.l~.~..O.l.a..~.O..a.d. ........ Street Map ]No ..... ~ .... Block No. ~ ........ Lot No .... conforms substantially to the Applicati, on for Building Permit heretofo~re filed in this office dated ..... .~.p~.~$..~,~ .......... 19.(~. pu. Fsu'ant to which Building Permit No. ~0~2 .:~. dated ..... ~p~i,l.~ .......... 196.~., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy for which this certificate is addttio~ ~.o one family dwelling issued is .... ........................................................................... The certificate is issued t,o ...~..~.~.~.~.~..~.~.~.~.~.i~; ........................................ (owner, lessee or tenant) of the afore.said building. .Suffolk County Departnlent of Health Approval ......................................... .................... ~ ..... >~. · .~..~..: ........... Building Insg~etor - FOI~i~ NO. 2 TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S O~:FICE SOUTHOLO, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3052 Z Date ..................... /L]~J~.....~.~ ................. , 196.0.... Permission is hereby granted to: ............... C.u*~eheg,~e ............................................ to ... J~aiZd..an...acldi.tion..an..,a,~..a;r,i.ztl~...d~a~liag ...................................................... ct premises located at ...tg/.$..,.~azai~..~i. ne~.ta...R~a~l ..................................................................... ................................... ~Ia.tt f~uak...~......N...kf. ....................................................................................... pursuant to application dated ............................ ~l~.:f~......~.~ ............ 19..6~., and approved by the Building Inspector Fee $.. ~'...0.0. ............ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 10 ........ Perrnit No .............................. Disapproved a/c ............. ~..~.? ................ :,v=;:.: ............................................. ................. (Building I nspec~or) Application No...?..~..~.,..~.,~..~'. ...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 drown 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 opplioant. 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 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 P, eguJations for the construction o,~ buildings additions, alterations, or for removal or demoBtlon, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ¢('Sig~'ofure of applicant, or nome, if c~ corpordtion)~ ...... ....................... (Ad'dress of applicant) State whether applicant is owner, lessee, agent, arch te~t, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .~(.~d.~..~Z ...... ~.~..C~LZ~ .................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title'of ~r~orate officer) 7~ /~ o( I ~'~ ~ 1. Location of land on which proposed work will be done, Map No.: ........................................ Lot No.: ...................... Street and Number ..(.~....~.~.~ ........ ~..~¢ .......................... ~.~.~.~-~.~ ....................................... Municipality 2. State existing use ~nd occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ...~.~..~.~,(~.[~. ............................................................................................ b. Intended use and occupancy ~ ~/~(~ 10. 11. 12. 13. Natqre of work (check which applicable): New Building .i .................. Addition ~ Alteration i ' Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. Estimated Cost .~.~ .~ 5..?.. .................. Fee ................... ~.(.....~... ........................................... (to be paid on filing this application) If dvJelling, number of dwelling units .............. /. ................ Number of dwelling units on each floor ......... /... .............. If gc] ge, roper at cars .............................................................................................................................. ] .............. If bqsiness, commercial or mixed occupancy, specify nature and extent of each type of use ...................... ] .............. · ~ · ~.r / 5// Dimensions of existing structures, if any: Front .........,~....~...~ .......... Rear ............................ Depth ........... ~'. He g, t ....................... / ~' / . .... Number of Stories ....... /. ........................................................................................ 4 .............. ' ~ Dimensions of same structure w th a terot ons or add t OhS' Front ........ ..~... Rear ~-¢' / Dept~ ......... .?'..~.. ................. Height ... ./.~ ....... Number of Stories ............. ../. ........... Dimtnsions of entire new construction: .............................. Rear 2 Z-x Depth /~ ~ Front ~'~¢-/ ............................................................ Heiglht ............ /?.. ............. Number of Stories ....... .'(. ..................... Size !of lot: Front ........ .]..0...~..~ .......... Rear ......... /....~..~..: ............. Depth ........ /..~..~..~.. .......... Dote'i of Purchase .......................................................... Name of Former Owner ......................................... ~ .............. Zon4 or use district in which premises are situated. /~'~)/,/2,,~-~//7,4/_ . Doe~ proposed construction violate any zoning [aw, ordinance or regu at onP ,P. : NanJe of Owner of prom ses .,~..~.~..~..,?..Y.....~...O.(..ff..~,. Address·...~..~..F.~.P.~.~.. ........................ Phone No ................... NonJe of Architect .................................................... Address ................................................ Phone No....; .............. Narrie of Contractor ~1/.?..(:~.~.~...~..../¢.P../?.~.~../~ .......... Address J..~.?.fl..//.~.~.~....C...~...7,~..~.~.(~v~.... Phone No. ~ .~.z~.E...~'..C.O-- ~ PLOT DIAGRAM Locaie clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimen: property lines. Give street and block numbers or description .according to deed, and show street names ant whether ir~terJor or corner lot. 166~ /o~r ons from indicate , ~[- 10~,~ STATE OF NEW YORK, ) COUNTY DF ............................ ) S.S. i . ................ t ............................................................................... being duly sworn, deposes and says that he is the qame of individual signing application) above nor/ed. He is the ............................................................................................................................................. . ............. (Contractor, agent, corporate officer, etc.) ' of said owger or owners, and is duly authorized to perform or have performed the said work and to make and file th s applicatiod; that all statements contained in this application ore 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 therewith. Sworn to Ue~re me this , ..... f , · .... ~//~.~ ....... ~.../~.~: .%.~ ................... ... ............. Notary Publ~.~.....~,....~,~ ~. nE~r~,~ (Signatu~ app~" ' / // ~UTARY PUBLIC, State of , (J ~o, 52-3233120 Suffolk Co~llty ~ ~ Term ~pJres March 30, )pplicont