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Home My WebLink About3168-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. 5ERTIFInAT£ 5F r'll~nU~ANGY THIS CERTIFIES that the building located at . ~[.~.U.g~.e.~...~.~.:[¥.e. ............ Street Map No .... ~ ..... Block No.. ~ ....... Lot No ...... ~I~II;...l~la.~.t. i[.t. tl.~.k.,...~.: .~: ..... conforms substantially to the Application for Building Permit heretogo~e filed in this office dated ...... Jtl&y. 22 .......... , 19.6ti pursuant to which Building Permit No. 116~..Z.. dated ...... tlll~.. 2~ ........... 19.~6., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy for which this certificate is issued is ... addition./1o, cite..//amlly..dw, elllng ................................... The certificate is issued to ...~l.ll/l~m. Ch~]~s .................................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......................................... FOB~M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLER~('$ OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3168 Z Permission is hereby granted to: .[l~,,le~,:..&ep]~o.....A.Jg.....~,...(~amb~.~.. ............. ~4e~L:~.~ck ............................................. to ~.2~.. · .a.~, · · a4L4~:g~.FL~Z~ · .e~. · · ~.~. · ez~-2.,~] ~.~ ~ - ~S~e~ ~.2.~g .......................................................... ct premises located at ....~...~J,(~.....~&~g.],~.3..}~,.~..~(~ .................................................................. ................................................. ~i~t L ~t~e~%..... ~ ~ .~ o ........................................................................... pursuant to application dated ............................. ~T~.~'. ....... ~. .......... ]9.~..., and approved by the Building Inspector Fee $.,.~.e.Q.O. ........... FOEM NO. I T~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 5 .......... Approved"" Permit No...~/...f..,~-Z..;~...~' D~sapproved a/c ............... ..................... ................................... (Building InspectJor) Application No..~.,.,..~,..~ ......... APPLICATION FOR BUILDING PERMIT Date ................................... .~...~..~.~.......~...~! ....., 19~...~.. ....... 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 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 York, and other applicable Lows, 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 oil applicable laws, ordinances, building code ~and regulations. Stan.ley Seiko (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................... C~n¢~,~. ~' .............................................................................................................................. Name of owner of premises ...... Wl~,....~l~t~b.~;('~ ................................................................................................................. 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.: ..~ ............... Street and Number .~.....~.~.8..~&~.~....~.¢.~..~*~* ............................................................. Municipality 2. State existing use and occupancy of premises and intended use an8 occupancy of proposed construction: a. Existing use and occupancy ....... ~e~. ...................................................... ~ ................................................. b. Intended use and occupancy ..... ~.~..~..~..~.~g~ ......................................................................... 3. NatUre of work (check which applicable): New Building .................. Addition ......~._. Alteration ...~,'f~ ..... Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estln~atedi Cost ....1,~O00..~./M. .................................. Fee ..~..~.0...0. .............. (to be paid on filing this application) 5. If d~elHng, number of dwelling units ...... me ............... Number of dwelling units on each floor -- If g~roge, number of cars ,~ 6. tf b~siness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dim?nsions of existing structures, if any: Front ............................ Rear ................................ Depth Hei~jht ........................ Number of Stories Dimensions of same structure with alterations or additions: Front ....................................Rear Dep(h ................................ Height ............................ Number of Stories ................................ 8. Dimensions/ of entire new construction: Front ....[.~. ........................... Rear ....... '].~ ................. Depth ....2.2 ............ Hei6ht .................... Number of Stories .... '~ 2)+0 ~'08 ........ 9. Sizelof lot: Front ............................ Rear .................................... Depth ]0. DatA of Purchase ........................................................ Name of Former Owner ] ]. Zon~ or use district in which premises are situated ...... ]2. Doe~ proposed construction violate any zoning law, ordinance or regulation? ............. TLO. 13. Nar~e of Owner of premises .....Wm~,..~h~t~e.~.s ...... Address ......~,.~...~,~.~...o..~. .................. Phone No. Nar~e of Architect ...................................................... Address ............................................ Phone No. Nar~e of Contractor ..... ~.¢,8,gl.e.~..8~.~O ................ Address ....... ~.t;,~.~.~lc ............... Phone No. PLOT DIAGRAM Locali dearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lilies. Give street and block number or description according to deed, and show street names and whether ia erior or corner lot. STATE aFl NEW Y~ORI~,, ,, ~ ¢ ~ COUNTY [OF ....... ~.~...ZLZ.'..O. ~ ........ ~' ~'~' ............... I ................. ,~8~'~,~'....,~6];t,~Q ...... being duly sworn, deposes and says that he is the applic I(Name a~ m&wdual s~gnmg apphcohon) above na~ed. He is the ......... Co~;~.a,e.t,o~ ................... (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 make and this cpp Jc'ation; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ ~rk will be performed in the manner set forth Jn the application filed therewith. Sworn to ~ afore me this ................ 22,. day of .................... .,.]'.g,.'l.~ ............. , 19..~. ~o, 52-3233120 Suf[oik Couut~ Term Exp]ree March 30, 19~'~