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Home My WebLink About3142-zFOP~I ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, P.E:RTIFIP. ATE: BF BggUPANgY No. Z 2595 Date OctOba~' 27 19.66 THIS CERTIFIES that the building located at . .0..a~...p~.V..~. ................. Street Map No?.~.!'.'.'???. ,.D. Block No. ~ ,Lot No, conforms substantially to the Applicati~on for Building Permit hereto~o,re filed in this office dated ,~.t~l]f ~ 19,.~.6. pu.rsuant to which Building Permit No. dated .......JtllY. ............ 1 . .... , 19.?~. ., was issued, and conforms to all of the require- ments ,of the .applicable provisi.ons of the law. The .o,ccupancy for which this certificate is a~ accessory b~ild.~ng issued is ............................................................................... The certificate is issued Ko ...~.~.~.~.0!~-~. ~.~=~=~' .... ............................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......................................... Building Inspector0/ FOI~M NO. 2 TOWN OF $OUTItOLD BUILDING DEPARTMENT TOWN CLER~('$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPTON THE PREMISES UNTIL. FULL · COMPLETION OF THE WORK AuTHORiZED) N? 31 2 z Permission is hereby granted to: ............. ~t~h~.~-.- ........................ : .................. Date · ~ ............... ..,,:..:..'...~.~u~:~.....,t~- ~ .......... ?.,'~, v..~. pursuant to applicatign dated .............................. ........... ~T~..~.....~.., 19.6~..., and approved by the Building Inspector Fee $'"~-00.,.'-1 ...... Building Inspector FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. ............................... ('l~'~'i'i~l'i';'~ ......................... 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 a detailed description of layout of property must be drawn on the diagram which }s 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 Yorl% 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 appl~ht, or name, if a corporation) ..................... ........................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. 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.: ?..~.,....4~,..~. .... Street and Number .... · ,~..,~ ....... :.~,r~-~ ............... ?.,' ... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~..../f(../~'.,,~.~.4~.. ...... .~..:~ ........... r.'./.~..~.~.. ........................................................................ b. Intended use and occupancy ....... ~../.~..~.~....(~./~.~. ........................................... ' ................................................. 3. Nat Rep, 4. Estit 10. 11. 12. ~re of work (check which applicable): New Building .................. Addition .................. Alteration ~ir .................. Removal .................. Demolition .................. Other Work (Describe) ~ated Cost ............. ~-~.. ~,5-,T.. ~. ,...~..~ ......................... Fee (to be paid on filing this application) if ~elling, number of dwelling units ............................ Number of dwelling units on each floor If g~rage, number of cars .......... If Di~T Hei! Dim Dep Dirt Hei! L.ocat, property Ii whether in' STATE OF COUNTY usiness, commercial or mixed occupancy, specify nature and extent of each type of use ensions of existing structures, if any: Front ...... ./..~ ................ Rear ..../..~ .................... Depth ....../..~.....~ Iht ..... ./..~ ............. Number of Stories ...... 4'.. ~nsions of same structure with alterations or additions: Front ........ ./.. ...~... :. ................. Rear ....... ./...~. .......... rh ..... ..~..~.. ................... Height ....... /..,Z, .............. Number of Stories ..../. .......................... ensions of entire new construction: Front ........ /..CZ ..................... Rear ........ ~...¢3..~ ........... Depth ............... iht ..... ./.. ............ Number of Stories .......... /. Size' of lot: Front ........ d,...¢.. ............ Rear .......... .~....~.. ................. Depth ...... /...&,....~. .............. Daf. of Purchase ........................................................ Name of Former Owner Zon ~ or use district in which premises are situated ..................... ~ Doe ~ proposed construction violate any zoning law, ordinance or regulation.;) .......... Nar,~e of Owner of premises~/.fT'~.~.,~.~A~Address ...... :.~..'....,.,...~;-~ ............. Phone No. Name of Architect ..................... ............. /~ ................. Address ............................................ Phone No. Nomel of Controc ./~. ....... Address/~..~.....(...~..~-~.... Phone N, PLOT DIAGRAM ~ clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fn ~es, Give street and block number or description according to deed, and show street names and erior or corner lot. NEW YORK, ~SS OF ................................ ~ '' ........... /?Z.: ................ being duly sworn, deposes and says that he is the /"/ (Name of individual ~id'ning application,) above na~ed. He ~s the ....... ~ ....... (Contractor, agent, corporate officer, etc.) of said ow~,ner or owners and is duly authorized to perform or have performed the said work and to make and this opplic,btion; that all statements contained in this application are true to the best of his knowledge and b~lie~; that the w~?rk will be performed in the manner set forth in the application filed therewith. Sworn to b~fore me this / f ......... /. ........... ~ . ............... , 19 ........ Notary Public, (Signature ~licant) [ NOTAI{Y PUB State of New fork , No. SuffoLk County I Commission res March 30, 19~