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Home My WebLink About3077-zFOI~M 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. P. Ei~TIFIEATE OF E3Gi~UPANP. Y No, . ,~.~.~21~.. · Date ................. THIS CERTIFIES that the building located at . .Vat3s~;o~. R<)~(I. ............. Street MapZ~oS. s.a..ti." .P..o.i.n..t. ~oUct~ ~or.O?.e..r.t.,f.e. ?... Lot No...36.1 .&. conforms substantially ~o the Applicati,on for Building Permit heretof(yre filed in this office dated .......... ~.~f .... ~ ....... 19. ~ pursuant to which Building Permit No..30r~7. dated ............ l~i~y ....~ .... 19~.~., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The ,occupancy f, or which this certificate is issued is . .. ~9ri.vate .one. t~.am.i.~y· dwe~:ti, ng ........................................ The certificate is issued to t~1,i~1.1 ~1. I)tt~altl' t~' F:~owner,'O~lle~essee' T~r]5.~ (~enant)'' r ............. of the aforesaid building. .Suffolk County Department of Health Approval .... Ne~ ............................. Building Inspector FOP~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S O~:FICF. SOLITHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3O77 z Date ........................... [~' ......... .6 .............. , lg(:f~ .... Permission is hereby granted to: Erne~.t...~O.~a~.....A~.C...~f. oD~tmham...&..F....Taylo~ .................... ~.¢.t.~,.t.uck ...................................... to ~.~ ~.~.. an...~d.d.~.t ~ ~.. ~r~. ~n..,ez¢ ~,~Lr~.. ¢lwo;~&~ .......................................................... at premises located at ...... ~fg~.....~,~..E'z...]~[..,~6~,~,..,J~'a~s~'~.;t,.,~.o:L~..}~;~.o~ ............................... ................................ .~.an~.~r..~.o~CLr..~a~aK..~.o$.nt.~...¢u~eg~e ....................................... pursuant to application dated ............................ ..~..a~.. ......... ,~. ............. 1'9~".., and approved by the Building Inspector // Building Inspector} POINT IPOR,M NO. I I~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~...(~)...~.....~. ........ APPLICATION FOR BUILDING PERMIT Date / 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 drawn on the diagram which is port 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 ir-~oection 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. APPLIC,~TION IS HEREBY ,Mu~DE 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, as herein described. The applicant ngrees to comply with all applicable laws,ordinance~:~uilding c ~~~~regul 'ans. ~.~g~noture of applicant, or name~, if a c~rporc~ion) (Address ~of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ............................... i ..................... ............................................................................. ama of owner of p em'sas ~-~...~,,..,.. ..................................................................................................................................... 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.: ~.'...~...~ ........... ~.'..t~/ ........ Lot No.'~../..~..~..~..~ Street and Number..~...~.~.?..~.i....,~.~ ....................~.~.,~..,5..~..~.....~....~...,.//./..."~'.~.......,~.. :~.... ~..~/..: ................ A~unicipality / ........ 2. State existi.ng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~.:i ./..:'..~.~....~...~..~...~.~..~..~..~. .................................................................................. ~ ,'- W%Z......~.p..~.~..,..~,.L...~...~.h:.o, ~/ ~..~...~..'~.......~.~ '~ b. Intended use and occupancy ~....~....l..~.b. ...... ...... ............................ 3. Nature of work (check which applicable): New Buildir~g .................. Addition / Alteration Repair ................. ~ Removal .................. Demolition ............ = ..... Other Work (Describe) ........................................ 4. Estimated Cost ...~'.~...~'....o...~..,.....o...~.. ............................... Fee ...C...~.~.....~....O. ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .~ .................. Number of dwelling units on each floor ~ If garage number of cars ~ ..~ 6. If business, commercial or mixed occupancy, speci~ nature and extent of each type of use ...... .~......; ............. 7. Dimensions of existing structures, if any: Front ....~.~ .................. Rear ...3. ............................ Depth ..."~....~'... .......... Height ...~..~.~.~.z..:.~,... Number of Stories ..... ../'.. ...................................... ; ............................................... ;,. ................ Dimensions of same structure with alterations or additions: Front ...~...~. ............................. Rear .....~?.. ................... Depth ~...~.. ......... Height .....~. ......... Number of StOr es ../... · 8. Dimens OhS of entire new construchon: Front .................................... Rear ............................ epth ........................ Height ~' Number of Stories .~. . · 9. Size of lot: Front .../.~.....~...'...~.. ......... Rear ....~.....'~'....~..:..~..~. ............ Depth ...~....~....~'....:..?.. ......... 10. Date of Purchase .....~...~.?....c...h. ...... /...~..~..o. ................... Name of Former Owner ....~..~'..?...5..~..'.~...!.~..~..:.~..~.°.P..~..~.T.'~: 11. Zone or use district in which premises are situated ................................................................. iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii 12. · Does proposed construction violate ar~y zoning law, ordinance or regulation? ..iZ~. ............... 13. Name of Owner of premises ...D..u.~../'...~..~...d'....~...~.~..~.?..-R....Address -...~'...~..,~.'$..~..*h......P...e.-.:.,.~..-x~,.... Phone No..?,.~..:...~'..'...5~...~} Name of Architect ...................................................... Address ............................................ Phone No ..................... ~'R -~'~' 7"/a/,.T'ea/,~'$ ~at,~V ~u,ec~ ~,4/"X~', Phone No. ~4'~'~&.g.:~ Name of Contractor .................. ~;. ......... : ...................... Address .............................................................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and blOCk number or description according to deed, and show street names and indicate wheth~or corner lot. ,_do' STATE OF NEW¥ORI~,,~ . /], [cS COUNTY OF ..~J~' ' / ~ ' "___J .................... ~....~......~. .............. being duly sworn, d~oses ~nd s~[.~* he is the applicant (Nam~eO~si~iv~ua~n~~ above named. H ' e ....~ ........ G:..~ ............................................................................................................ (Contractor, agent, corporate o~er, etc.) of said owner or owners, and is duly authorized to perform or have perfo~me8 the said work and to ~=ke and file this application; that all statements contained in this application are true to .the best of ~is knowledge and belief; and that the work will ~e performed'in the manner set forth in the appJrcotion filed fherewith. Sworn to before me this 19..~.~. ............... o, ..... ................... . ..... ............................. ~ ' ' NOTARY PUBLIO, State ~ ~w ~or~ ~ ~ No, 52-06J8]00 SuJfo~ Cou~ ' v Commission ~p~ ~h ~ 1~