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Home My WebLink About3143-zFOR~ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'l"OWl~ CLERK'S OFFICE SOUTHOLD, N, Y. I:II~I~TIFII:IATt~ I~lr CI[ICIUPANI~¥ No... ~,. 2584' · Date ....... Oc~:~/l~e~e · 27 .......... ,19.. 66 THIS CERTIFIES that the building located at Klrau8 'R~a(I .................. Street Map No. ~X ........ Block No .... X]~ ..... Lot No .... conforms substantially to the Applicati.on for Building Permit heretof.ore filed in this office dated ....... Jllr~e' '30 ......... , 1966.. pu.rsuant to which Building Permit No. '3].4'3 'Z' dated ....... ~'UJ/y"l' ........... 19. '66' was issued, and conforms to all of the require- me.nts ,of the .applicable provisi.ons of the law. The .occupancy f. or which this certificate is issued is .... 'adOt'tll. on· ~:o' ~et~e' 'f~lrr~ltZy' '(l~,eJ.['ing' ................................. The certificate is issued to ..... ~l~a~a 'l)l~l~t'l~i[~[;~}t;~: '1;~;; ';~ 't;}l'il~t') ........... of the aforesaid building. .Suffolk County Department of Health Approval ......................................... Building Ippect6'r~ FO~FI 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) N? 3143 Z Permission is hereby granted to: at premises located at ..~'T~.D.....K~-~...,.~O~t~...~ ......................................... ................................................... ~,~.?,~-;L-t:,~ ....... .~t.,.~*; ............................... :.....L.: ...... Z...~...;L: ........... pursuant to application dated ................................... ~I~.....~).,.,., 19:.~., ~hd. approved by th~ Building Inspector Fee $.*~ mO..~ ............ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BU"LDING PERMIT Date 9 ...ZU v°/4 , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building ~nspector. b. Plot plan showing location of Jot 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 shah 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 pa rf for any purpose whatever until a Certificate of Occupancy shall have been g~anted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building ~ermit 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 law~, ordinances and regulations. ~ n (Signature of applicant, or name, if a corporation) (Address of~licont) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............. .............................................................................................................................................. Name of owner of premises ........ ..~..,r~,.~..~,..Z~.,..~.. ..................... ./....~_. ................................................. if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) i. Looation 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 ....... ~...../'f~......~/~......~....~....~...~.-q. ................................................................................ b. Intended use and occupancy ..... . .~..,...../rid.......~.....~.. ~...?.~.,....~.. .......................................................................... Dep 8. Dim Hek 9, Size ]0. Dob 1 1. Zon 12. Doe 13. Nor Non Nan L.ocot~ property Ii whether in1 I NotJ~re of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repgir .................... R~oval .................... Demolition ....................~Other Work (Describe) ........................ ' (to be paid on filing this application) ~ ~ ~ of dwelhng un,ts on each floor ........ ~ ......... If d~elIing, number of dwelling units ............ ~ .............Number · . / 'o o~ If g~rage,' number of cars .......... ~ .......................................................................................................................... f ~us ness, com~rc aI or m xed occupancy, specify nature.and extent of each type of use ............................ D mensions of ex stina structures, if any: Front.....~ .............. Rear ...... ~..~ ........... Depth ..... ~..~ .............. Dim'ensions of same structure with alterations or additions: Front ..... .~. ................. Rear ...... ~..~ ............ :h ...... ~< .................. Height ....../C~...~... ................ Number of Stories .Z ........ ~nsions of entire new constructign: Front....... .......................... Rear ............................Depth ........................ ht ............................ Number of Stories .................................. of Purchase ~..~ .... Nome of Former Owner ~/~Z/~ proposed construct on rio ore ony zon n~ ow~ ordnance qr re~u~otion? ...... .~..~ .... PLOT DIAG~M clearly and distinctly all buildings, whether existing or proposed, and indicate ~1 set-back dimensions fr( ~es. Give street and Block numbers or description according to deed, and show street names and indic, erigr or corner lot. STATE OF NEW YORK, ) S S COUNTY OF ............................ ) ' ' ........... ....... ....................................... be,ng · (~l.ame of individual signing applicon) above nam ed. He is the ............................. .1~<...~)...~.... duly sworn, deposes and says that he is the applico of said owner this applic and that Sworn to Notary Pul (Contractor, agent, corporate officer, etc.) or owners, and is duly authorized to perform or have performed the said work and to make and ~tion; that oil statements contained in this application are true to the best of his knowledge and ~e work will be performed in the manner set forth in the application filed therewith. '~ f° re dn~ to~iS 19 ...... ~ ........... ' ..:...:/J /~. /~~. ... ' lic ............................................................. County ~7 ............... (Signature of applicant) .....