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HomeMy WebLinkAbout3098-z~OR~ ~0. 4 TOV~N OF $OUTHOLD BUILDING DEPARTMENT 'I'O~'ll C~-ERK'S OFFICE SOUTHOLD, N. Y, P. EI~TIFIE:ATE OF E}E:E:UPANE:Y No. Z. 2~.~6 .... Date ............ 0ato~er...1.~ ..... 19.66 THIS CERTIFIES that the building located at .Ga'gell~ 'L~It~'J:~g' 'Roar ..... Street Map No....~.~. ....... Block No ..... ~ ..... Lot No...Y~XX ..... ~Ol~hOl.d~. ]~,Y, ..... conforms substantially to the Applicatf, on for Building Permit heretof.ore filed in this office dated ........... ~ffa~... ~O .... 19(:~. pursuant to which Building Permit No.. ~x39~, .~ dated ............ .Nay.....~0.., 19'~6, was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The ioiccupancy ~or which this certificate is issued is .. P.I'lV.a~a .one. famf~ly. (lwe~:li.ng ......................................... The certificate is issued %o .LeO .I~a%tS¢:h ....... 0w~ler. ............................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ....... 0e,.t; .. ,~,1+~..2[96.6...by./{,..V.~I~a FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥, BUILDING PERMIT (TH!S PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: to ~ ~ ot premises located at ...J~/~.....Gagez~..~i~6..~o~d ................................................................... pursuant to application dated ............................ }~.~ .............. ..2..0.. ...... 19...~..~..., and approved by the Building Inspector Fee $..~.0.. O~ .......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH 0 CT I ~ Ig66 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure (~¥e deed located have been inspected by this department and found to be satisfactory. Distriot Engineer District Engineer FOP~i~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ .~......, 19 ....... Approved ................... ~ .................. , 19...~.'.... Permit No...~.....~... ................... ~ Application No. _~C) ~ ~ Disapproved a/c .............................................................................................. ................... ................................. APPLICATION FOR BUILDING PERMIT Date ............................. ~&M.....~.Q .............. , 19..6..6.. ...... 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 a detailed descrip[tion of layout of property must be drown on the diagram which is part of thb 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 laws, ordinances, building code and regulations. Leo Rausch (Signature of applicant, or name, if a corporation) ................... ~ o.u.vhol.d ........................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, ena, i,neer, general contractor, electrician, plumber or builder. 0 wner - Name of owner of premises ..... Leo..~s.usah ....................................................................................................................... If opplicant 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.: ............ ~Z. ...................... Lot No.: ...... ~! ............. ' Street and Number ..... G.~g.~.D...~d~..~d ............ ~.O.~.t.h~.~ ......................................................... Munici~lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........... M.~.~..~.~ ............................................................................................. b. Intended use and occupancy ........ oae...~a,..~]M...d~i~g .................................................................. / xxxx 3. Natgre of work (check which opplJcabJe): New Building Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................... 4. Esti~nated Cost ........... ..]:.~.~..0...0..0...?./.~ ........................ Fee ........ .~...0. ........................................................................ (to be paid on filing this application) 5. If d~elling, number of dwelling units ............................ Number of dwelling units on each floor % ..................... If g~rage, number of cars ........................................................................................................................................ 6. If 4usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................ Din~ensions of existing structures, if any: Front ............................ Rear ................................ Depth ................... 7. Hei~lht ........................ Number of Stories ............................................................................................................ i Dim]ensions of same structure with alterations or additions: Front .................................... Rear ........................ Dep}h ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .......................... ~.~ ..... Rear ...~ ..................... Depth ..];~./.~.~ ..... Hei~lht .................... Number of Stories ................................................................................................................. 9. Siz~~[of lot: Front ......... .~...0..0.. ........... Rear .......... 2..0..©. ................... Depth ...,~..~..Q ..................... / Former 10. Dat~ of Purchase ................. ]L.c~ .............................. Name of Owner .................... ~.e~ ................... 11. Zonle or use district in which premises are situated ....].~..A..]!...~.~ ......................................................................... 12. Doe,~ proposed construction violate any zoning law, ordinance or regulation? ....................... .D.O .................. : ......... 13. No+e of Owner of premises ...... .~..e...o...~flg..~. .......... Address ............. ~.g.~Z~O.[L.~ ............ Phone No ................ Narhe of Architect ...................................................... Address ............................................ Phone No ................ Na~e of Contractor ........... ~.~..~.e. ................................ Address ............................................ Phone No ................ j PLOT DIAGRAM Locat~ clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fr property ines. Give street and block number or description according to deed, and show street names and indic, whether in 'erior or corner lot, STATE OFINEWYORK, COUNTY pF...¢~O]~ ............ ...................................... Le.o..~a.~..s~'t .................................. being duly sworn, deposes and soys that he is the opplic< IName of ndividua signing app icotion) above non'ed. He is the ...................... C)~p,.r...m..b. ui~,z: .......................................................................................... (Contractor, agent, corporate officer, etc.) of said ow,per or owners and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and belief; that the w~rk will be performed in the manner set forth in the application' fiJ~therewith. Sworn to before me this , // / ~0 da,, of . Nora ry puflic, ..~.~....l~.,....~ounty''''''/~''''''~ ........ ~f' ~ii:~ ' I NOTARY PUBLI~, Stu~ c, .', v .,~.,~ No. 52-3233120 Std~ol~{ 6oul&v I Term Expires ~arch 30, 19~(~7 :