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Home My WebLink About3178-z~ORM ~O. 4 ?OWI~I OF SOUT~OruD BUILDING DEPAETMENT 'I"OWI~ CLERK'S OFFICE SOUTHOLD, N, Y, I::}EI~TIF'II~ATE OF OOrI. I.IPANOy No.. ~..2622... Date ........... ~)ece~be:V. · .3.2 ...., 19 THIS CERTIFIES that the building located at ...~.~S 't]o~ky 'P~ 'Rc~a~l ...... Street conforms substantially to the Applicati~on for Building Permit hereto~vre filed in this office dated ........... Ju.]:y...~8...., 19.(~(y pursuant to which Building Permit No..31~.Z. dated .......... A~g.,.. ~ ..... , 19. ~ was issued, and conforms to all of the require- ments ,of the .applicable provisions of the law. The ,~ccupancy f, or whict~ this certificate is The certificate is issued t,o . ~t;a~.~-ey. ~. t~a~lell~';~l~,eq~'' "-'. (~r~e~ .......... of the aforesaid building. ,Suffolk County Department of Health Approval . .]~O(l~ ..... ~' ']:~6~' · ]~y' 1~' ............... ;". ......... '\'~2 ' ~ ' ' ' ' ' ' '. '~ .... Bmldmg Inspector FOP~M NO. 2 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOWN CLE~.K'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3178 Z Dote .................... Permission is hereby granted to: : ................. ]3o:c....~9 ............................................... ............... B~ck~.. ~.~,.~ ........ ~¢.~.~ ............. ............. to .Bul~,c~ n~ ~ .f~i.t.y, r~e.~.~%~;. ................... ~, ..................... at premises located at .~0.~,,..~. .............. ~,~Z~raO~..:~S.~a.~,~...., .................................................... ..... W/.$ Ro~k.~ ~.oi~*.~ ~::~d.~- .Ea. st. i~a:~io~ ...... .~...~ ................. pursuant to application dated ................................. ~%}];.~.....]:~...('...., '19..(~., and approved by the Buildino Inspector Fee $..~LQ,D0 .......... ' ', 'B. uilding Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The ~age disposal facilities for a structure located (Give-deed location) have been inspected by this department and found to be satisfactory. D.% ~%~%~r {JR~znMs~ in e e r , \ FORM NO. 1 3~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. E×om,ned ........ Approved .,. ............................... ~....., 19 ........ Permit No ............................. Disapproved a/c ............. ~.~ ................ ~?.~..~ ...... ....~--- Application No. '31 7 ~C~-' APPLICATION FOR BUILDING PERMIT D0t .......... ........................... , l .i.L ....... 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, end giving a de,ailed descriptiori 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 perr~it 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 all applicable laws, ordinances, building code and regulations. (Signature o applicant, or n~e, if a corporation) ......... ....... (Address of applicant) ~, / State whether applicant is owner, lessee, agent, 6rchitect, engineer, general contractor, electrician, plumber or builder. , ......................... ............................................................................................................................................... ."Name of owner of premises ......... ..~....~.~.~,~...~...~.~ ............ .~.~.~.~.~.O..~O..: ....................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of c~orate officer) 1. Location of land on which proposed work will be done. Map No.: ...... ~ .....~ .....at No.: ..~ ................... ..... Streetr and Number ....~..~%...~O.*~...~.Q~..~, ............... ~.~.....~..~.~ .................................... . Mun c ~lity 2. State existing use and occupancy of premises and intended use and ~ccupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ................................................................................................................................. 3. NatUre of work (check which applJcaNe): New Building .................. Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estir~ated Cost ............................................................ Fee (to be paid on filing this application) 5. If d~velling, number of dwelling units ............................ Number of dwelling units on each floor if g~rage, number of cars ...... 6. If b~usiness,l commercial or mixed occupancy, specify nature and extent at__each type of use 7. Dim~,nsions~of existing structures, if any: Front ......~..~..~..?.'. ........... Rear ................................ Depth Height ........................ Number of Stories Dimensions of same structure with alterations or additions: Front ..... ...P~..?...~...~. ................. Rear" Depth ................................ Height ............................ Number of Stories ................................ 8. Dimbnsions of entire new construction: Front ~/L ~. 2, I He~6ht .................... Number of Storms ..................... .~ .............. ]0. L~or at ~urcnose .................... ; ........ ~ .......................... ~-¢ome ? ] ]. Zon~ or use district in which premises ore situated ............................................. i~'/ ....................... ]2. Doe{ proposed construction violate any zoning Iow, ordinance or regulahon? .._/...7.?..: ......... ,; ......... 13. Nar~e of Owner of prem,ses .................. .~ .......... ....... Address ................ "~""~"']'"":"1 Name of Architect ........................................... . ......... Address ............................. .~,~ .......... Phone No. / ! PLOT DIAGRAM L.ocat~clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-bock dimensions fr property Jibes. Give street and block number or description according to deed, and show street names and whether in~'erior or corner lot. STATE OFJ NEW YORK, COUNTY ~F ................................ ................................................................................................ being duly sworn, deposes and says that he is the Name of individual signing application) above na~ of said ow this applic that the w~ Sworn to b ;fore me this ........ day of ...... ........ , Notary P,!~¢~ ....~(..~~County ed. He is the (Contractor, agent, corporate officer, etc.) ~er or owners, and is duly authorized to perform or have performed the said work and to make and ~tion; that all statements contained in this application are true to the best of his knowledge and belief; ~rk will be performed in the manner set forth in the application filed therewith. (Signature of applicant)