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Home My WebLink About3151-zFOR~ ~0. 4 TOWN OF SOUTHOLD ]~JILDI]N G DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDo N. Y. EIEI~TIFll~AT£ BF' I~I~UPANI~¥ No. Z. 2)+88 .... Date ............... A~i§U~%...~ ...... 19.66. THIS CERTIFIES that the building located at . .~./.~...~:].~D..~}.~.O~.~ .~6..~20.. Street Map No...~ ........ Block No ..... ~ ..... Lot No. XX .... ~.~;l.~/¢k~. K~Y, ......... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated .............. ~t~.. 8.., 19~6.. pursu'ant to which Building Permit No.~}t~.1. .~.. dated ............. ~Iuly'"l'~" 1966" was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy ~or which this certificate is issued is .... P.X'I.v. ata. ga~ra~e ........................................................ The certificate is issued %0 ~ ....... JO~. ]~iSl~ ......... ~%~D~1~ ....................... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval ....~.~..~.~. ................................ FOR~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 3151 z Date ................................ ~T.~L~j.....~,~. ........ , 19..~. Permission is her. eby granted to: ..... ~.o~..~.,...~a ........................................... ............. ~.t.~.~ze~. ............................................. to .. ~u,J,~ .. ~,~..~¢,8,~.~c~.. ~.. ~ ..e~z. ~r~ &~%.,.. ~e ~se~. J~ ~(~ ~g ............................... at premises located at ..... ¢/~.....]¢~I~:~.~..~(¢. &~. ....................................................................................... ...................... ~4~;z;~,C;~,t~.....~.o.'~., .............................................................................. : ...................... pursuant td application dated .......................... ~'~ ....... ]:,~ ............. 19~¢~..., and approved by the Building Inspector Fee $.~'~ 09 .............. FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (Building inspector) / APPLICATION FOR BUILDING PERMIT Dote ....... 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 is pa~rt of this application. c, The work covered by this application may not be commenced before issuo.nce 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 acjrees~ to comply with o app icab e aws, ordinances, bui ding code and regulations. (Signature of applicant, or name, if a corporation) · ............ (Acldress of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ....... ....................................................... i ............................................................................................... Name of owner of premises ..... ? .... ."-~ ......... .~. ..................................................................................... If applicant is o 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.: ........ ~4~.~'~ .............. Lot No.: ...,?..~.../../(.,~.."~. .... Street and Number .//. ~.~..,~....~.~?.....~.."~./.,4~..... ,~....~..~i ................................ ../.../~.r~.. ?...~.//.-~../.7~.~.~. ................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. £xisting use and occupancy ...... .~..,~.~.~.....~.~.,~..,-~ ....... ¢~.,~.~.~.~Z'/~'~.'~. ...................................................... b. I ntended use and occupancy ....<~../.~.~.A~......~./..'~'...y~...~'.. ......................... : .................................. ~ 3. Nat~ Rep~ 4. Estir 5. ~re of work (check which applicable): New Building .................. Addition .................. Alteration ............... rir .................. Removal ..... .j~.;.~,.. Demolition .................. Other Work (Describe) .................................... ~ated Cost ........ ~-~.. ;.~':~'). ........................ Fee .................................................................................... (to be paid on filing this application) veiling, number of dwelling units ............................ Number of dwelling units on each floor ....................... If c~ irage, number o~f cars ......... ~..~. ................................................................................................................ If usiness, commercial or mixed occupancy, specify nature and extent of each type of use ....................... Din',ensions of existing structures, if any: Front ........ ~:...z. ......... Rear .......... .~...~..:../. ........... Depth ...~...~ ...... Hei ~ht ..... ./...~...../. ........ Number of Stories ....... ~J'z~.'.~Z...~... .................................................................................... Din ensions of same structure with alterations or additions: Front ....... ~.:..~.....~. ................ Rear ....... ¢~.......~..../... De~ th ..... ~...4.~...~. ................ Height ....... ~ ................. Number of Stories ...... ~...~...ZZ..~.. .......... Din ensions of entire new construction: Front ...... ,,,~..~ .................. Rear ......... ~..c~..../. ....... Depth ....~)....~ Hei ~ht ....~). ........... Number of Stories ........ ~'~...~?...~'... ...................................................................................... ) ............ ../'. ~....~. ......... Depth .......... ~...../. ...... Siz~ of lot: Front ...... .~,..~...~.. ........... Rear Dat of Purchase ........................................................ Nam~g_of Former Owner ............................................ Zor~e or use d,str,ct ,n wh,ch premises are s tuated ..... ...~..<~'.,r~./.~....~....~.C...~. ...~2../~.'....~... ................... Do~ proposed construction violate any zoning iaw,.ordinance or regulation? ....... ,~2...<'Z~... ..................................... Na, ne of Owner of premisesC'~/~. ~'. ~,ZL,c..~.'~..Address .~¢'~.....~.~.,. .......... Phone No.~..,'P-~...~ Na~ ~e of Architect .......... ~I'/.~_.}~.. ............... ~ ......... Address ............................................ Phone No ............... Na~ ~e of Contractor .......~Mc~.~...~.. ....................... Address ............................................ Phone No ............... 10. 11. 12. 13. PLOT DIAGRAM Locat,'e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property I nes. Give street and block number or description according to deed, and show street names and indk whether in}er or or corner lot, I STATE O~ NEW ,Y,~R.K~,,.--~/,' } c ~ .... ~ .~.~.....~..~.....~..~..~. ................................ being duly sworn, d~oses and says t~;t he is the opplh I (Name of individual signing application) above na~ed~ He is the ....~~ ........................................................................................................................ J (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to mo:ke and this appl :arian; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ ark will be performed in the manner set forth in the application filed therewith. Sworn to efore me this ........................ dov of ............................................ , 19 ........ ......~ .... 2....~.., ............................ Notary ~blic, . ........................................................... County ~ (Sion~turo of ~pplic~nt)