The URL can be used to link to this page

Home My WebLink About3094-zTOWI~ OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. EEI*.TIFIOATE 13F EICI~LIPANI~Y No. Y~. 257.~. .... Date ............... 013~;O~30~... 2.5.., 19.6(> THIS CERTIFIES that the building located at ~.~{. ~aso~3. I]~ ............... Street Map No....~.~.Q~ .... Block No .... ~ ....... Lot No.. ~...(~]l~;~.~Ogl~$. 1~,~.,. ........ conforms substantially %0 the Application for Building Permit heretofore filed in this office dated ............ ~ay...~.8 .... 19.66 pursuant to which Building Permit No..3Q91~. ~ dated ........... ~M~.~....~ ..... 196~., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy f~or which this certificate is issued is . .~¥a.tie. o:4i~). ,fa~i3,~/. -~.~,$el.)..~g ......................................... The certificate is issued t,o . ~.~ .~. i~,ff~ ....... ~le~ ............................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ........... ~g,. ~, ....................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW~ CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING (THIS PERMIT MUST BE KEPT ON THE PREMISES uNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: pursuant to application dated ................................... .~.~. ....... ~ ...... 19~..., and approved by the Building Inspector Fee $.. ~.. ,..Qg. ............ FO~M NO. 1 TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................" , 19 ........ Permit No. ''3 (~) D~sapproved a/c ............... ~ ........ ;,~ ...... ~. .......... u ....... ~. ............. r~,,..,,,~ ......... / (Building Inspector)/ ! APPLICATION FOR BUILDING PERMIT Date ........................ ~. .......... ~ .............. , 19.~.~. ...... 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 H.EREB¥ MADE to the Building Department for the issuance of a Building Permit pursuant to lhe 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 laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) ............. ~a.'~ ~t.~u~k.~...N,~..~ ................................................ '(A-ddress 8~ applicant) State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder. .......................................... C~8,~%~Z~ ............................................................................................................................... Nome of owner of premises ..~..l~,..1%t,i:;['.~ ....................................................................................................................... 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.: ................ ~ .................. Lot No.: ..... ~'{f, ........... Street and Number ..~.i{.....ltla~to~..D~.$~.G,~.....gm, t.~h~/~ ............................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ........ ~we11~ ........................................................................................................ b. Intended use and occupancy ........... ~e..w$~h..~...a~o~ ................................................................... 3. Not, Ire of work (check which applicable): New Building .................. Addition ...;Z. II~ ....... Alteration ............... Repc ir .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Estir ~ated Cost ....... 3~JOQ..[~/~[ .............................. Fee ........ .~ ............................................................................ (to be paid on filing this application) 5. If d,~velling, number of dwelling units ....... 4)~ ............. Number of dwelling units on each floor ........................ If ggrage, number of cars ......................................................................................................................................... 6. if b,[usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 7. Dimbnsions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Heifllht ........................ Number of Stories .................................................................................................... .......... Dimensions of same structure with alterations or additions: Front ....................................Rear ........................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dim?nsions of entire new construction: Front ....... ..~l+ ........................ Rear ........ ~.~, ............... Depth ..... J~.t ......... Height .................... Number of Stories ...... Ot~ ..................................................................................................... 9. SizeJof lot: Front ............................ Rear .................................... Depth ................................ 10. Dott of Purchase ........................................................ Name of Former Owner ................................................... 11. Zonb or use district in which premises are situated ............ ~J~"..Cz~t.'i~j ........................................................ ; ......... 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ............ ~ ....................................... 13. Name of Owner of premises ....~,~...D.'~l~..~r. ........... Address ...... ¢~t.~lZ~ ................ Phone No ................ Nar~e of Architect ...................................................... Address ............................................ Phone No.., ............. Nar~e of Contractor ...... ~...~e~O~][,t ................. Address ......... [~,~.l~..t;~t~k .............. Phone No ................ j PLOT DIAGRAM L.ocat~clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f~ property li)~es. Give street and block number or description according to deed, and show street names and: indic whether in~ .~rior or corner lot. STATE OFf NEW YORK, ~, ¢ ¢ COUNTY '.OF ...St~.~e[~, ........... ~'~' above nan of said o~ this applic that the W,~rk will be performed in the manner set forth in the application filed therewith. Sworn to b~efore me this · l~t' day of ~t..~ 1 9 .............. x .............. , I , Notary Public, .J;~.j~,¢,,...~..,...~.(~.~,,,,.,[~ Coun,~, ~ ~[0[~' ' (Signature of ................... ~T~,~DJ.~..~;)~e~'&C~S~;~I, ..................... being duly sworn, deposes and says that he is the applic Name of individual signing application) ed. He is the ............... (~O~IG~'e.~;GZ' ............................................................................................................. (Contractor, agent, corporate officer, etc.) ner 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 are true fo the best of his knowledge and belief; ,licant)