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Home My WebLink About3089-zTOWN OF SOUTHOLD BUILDING DEPARTMENT ~"OWN CLERK'S OFFICE SOUTHOLD, N. Y. I]EI~TIFIOATE QF Qr.I]UPANO¥ No. Z..2~ .... Date ......... .~.~l..~.~....2.~ ............. 19.6,6. THIS CERTIFIES that the building located at .... ~/.~..];ee.t011..~l';~ve ...... Street Map No ....... .X~..~/~... Block No ...... .Y.~:. .... Lot No. ~ .... .~.O.~..~}.1.O..1.~.{...~.~.¥.~ .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ .~f. .... ~.~ ....... 19.6.~ pursu'ant to which Building Permit No..30.~9. ~ dated ......... .~.~. ....~.6 ...... 19..6~ was issued, and conforms to all of the require- me,nts ,of the applicable provisions of the law. The ,occupancy ~or which this certificate is issued is ....1ltl;Lite..&, .too1. l~3use ................................................. The certificate is issued to ........ A.~exa!qc~x~. O~r ........ O,~/lqa~' .................... (owner, lessee or tenant) of the afore.said building. ,Suffolk County Department of Health Approval ......... I~ ........................... FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3089 z Permission is hereby granted to: .................. at premises located at ........~¢~,~,~ ......................................................................................... .............................................. ~outb~l~, ~o~. ............................................................................. pursuant to oppiicatlon dated .............................. ~'t,3r ........ ~L~ ............ 19.~.~.., and opproved by the Building Inspector Fee 10o O0 Building I nspecto~"~ TOWN OF SOUTHOI. D BUILDING DEPAI~T/v~I:NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ...................... ~ ................ , 19 ........ Permff No. Disapproved a~~ .... ................................. 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 drawn on the diagram 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 for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances and regulations. ....... ........................................................... (Signature'of applicant, or name, if a corporation) ................... ...... ....... .................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ................................................................................................................................................................... Name of owner of premises ....~...~..t~.....~..?.~.......~....~.~ ........................................................................................................ If applicant is a corporate, signature of duly authorized officer. 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number ............... Z ....................... ~ .................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy .~...r.c.~.~.. f~.¥:.~.~ ~('~,,~o~,~ 3. Naiure of work (check which applicable): New Building ..?~.. .......... Addition .................. Alteration ..... ........ Re~air .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Es ated Cost ............ ~.'~..~ ..................................... Fee ..................................................................................... I (to be paid on filing this application) 5. If d~elling, number of dwelling units .............................. Number of dwelling units on each floor ....................... If g,larage, number of cars ............................................................................................................................... ] ......... . 6. If bus~ness, commercial or mixed occupancy, specify nature.and extent of each type of use ............................ 7. Din ensions of existing structures, if any' Front .......................... Rear .......................... Depth .......................... Heir]hr ............................ Number of Stories ............................................................................................... . ......... Din,ensions of same structure with alterations or additions: Front ................................ Rear .................. ......... De th ............................ Height ................................ Number Of Stories ........................................ 8. Din ensions of ?tire new construction: Front ...... ~. ....................... Rear ............... ,g>. .......... Depth ...................... Hei ht ..... //. ................... Number of Stories ....../ .......................... 10. Dat~ of Purchase ........................................................ Name of Former Owner / 11. Zor~e or use district in which premises are situated ............................................................................................. Do,s/ proposed construction violate any zoning aw, ordnance or regu at on? .'..2,:.~. ............................... ....... 12. Na~e o Architect ...................................................... Address ............................................ Phone No ................ Na~e of Contractor ....~...~..~..:. .~.~ ....................... Address~... ~ ................ Phone No .......' ......... J PLOT DIAGRAM Locatle clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fl property I(nes. Give street and block numbers or description according to deed, and show street names and ndi~ whether in}erior or corner lot. STATE OI} NEW,YORK, ) COUNTY/OF ,~:~4~, .~.¢..~..~.. ......... ) S.S. above nan of said ow this applic and that ~../.')/.~.~.(~..,2.....~/~.,.....Z~2..(.(f'..~(?. ............................. being duly s~orn, deposes and says that he is the applic N.ame of individual signing application) ed. He is the x~.~./.Z~.,~.~. (Contractor, agent, corporate officer, etc.) ~er or owners, and is duly authorized to perform or have performed the said work and to make and :tion; that all statements contained in this application ore true to the best of his knowledge and bel ~e work will be performed in the manner set forth in the application filed therewith. Swam to kefore me this /~_:Z ~ dayof /~/4 .~. ,'~" · 1.9/~' /'~J,~ ~ 0, ~ ~, ~, .............. F ...... T~ "~';"~'"' '~' .......... ~:(~'~'t~:'~'i~. ~JL"'.....~.~.~ ............. ~..~..~) ' . ' NOTARY PUBLIC, S ~te ~ ~ rk Si n t Notary Pu~l.c~~.~..s].~6,~,.~,,......~..~, ~ ~, ( g aure of applicant)