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Home My WebLink About3179-zFORM I~0. 4, TOWN OF SOUTI~OLD BUILDING DEPARTMENT TOWN CI~ERK'S OFFICE SOUTHOLD, N. O~-I~TIFIOAT~' 0~' O00UP~NOY No..Z2~20. .. Date ............... Se.ptembe~.. ~.., 19.66. THIS CERTIFIES thit the building located at . ~,,~[/.$..Sti~lwater..A.v.e ...... Street Map No. M,;o,~and. Block No ............. Lot No. 9B..&29. · .qug. qhogue.~ .N.,.Y, ..... conforms substantially to the Applicat}on for Building Permit hereto3ore filed in this office dated ......... J[~g:~st...2 ..... 19.~6. pursuant to which Building Permit No. ~7$.Z. dated ............ A~.t .2..., 19.6~, was issued, and conforms to all of the require- merits .of the applicable provis[ons of the law. The .oleeupaney ~or which this certificate is issued is ... Pltivate..o~ .f~il.7. ax e' a,i g ........................................ The certificate is issued t,o .. ~t~..~.ieo ....... ~gOP ........................... (owner lessee or tenant) of the More.said b~ilding. .Suffolk Count~ Department of Health Approval ......................................... FORiVl NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUiLDiNG PEP. MIT (THIS PERMIT MUST BE KEPT ON THE p~EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ' N? 3179 z Vote i ~ i~"~--.~.~ ~, ~9 % Permission is hereby granted to: ...... ,.~.o~,t~.i-~L.i:=.....~:~...L.i;..:.!..L. ........ ........... ~.~,~:a~.r..~,.~;. ....... ,...L ........ ................................. ~u~og~.:.:.: ................... ..... .~.~.. ~.. aO~g~o~..&., r~,..~,ex~..o~.. ~,~x~g.. ~mX~:..... ct premises located at ..... .~...0..~. .............. .~..~..~..~.t.~¥t~ .................. ; ............................................................ ........................... ~.~:[~,,l~m.t.~r...A.v.e ............ .C..~..e..t.~..o.g~.e..~...,.~..~.,. .................................................. pursuant to application dated ............................. .~.~.g~2.$...~.......2. .......... 19..6..~..., and approved by the Building Inspector Fee $....~... ................. .......... ~ .; ....... .~..¥.~ ............. Building Inspector [ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN Ci~ERK'S OFFICE ........ Examined ,~-....~...., 19 Approved ........................................ , 19 ........ Permit No ............................. Application No ............................ APPLICATION FOR BUILDING PERMIT Dote ..... ~.~...~ 2 t966 INSTRUCTIONS o. 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 BuilSing 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 port 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, additiQns or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and ~egulations. Edw, Pukies (Signature of applicant, or nome, if a corporation) Stil]~a~er Ave &' Track Ave (Address, of applicant) State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder. ..................................................... .~w~e ~.- ......................................................... : ..................................................................... Name of owner of premises ..~.~),..]~-15~;8....~~. ............................................................................................................... If applicant is a corporate, signature of duly aufhdrized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .............. ~.~.e.~ ...... Lot No.: ........................ Street and Number ..~a~..A~...~..8.t~lwa~..A~ ....... ~g~e ....................................................... t Munici~lity 2. State existing use and occupancy df premises and intended use ond occupancy of proposedconstruction: / a. Existing use and occupancy .......... ~ ..................................................................................................... / b. Intended use and occupancy ......... :~..~.~..~..~..~..~~.....'. ........................... 3. Nature ~f work (check which applicable): New Building .................. Addition ..... ~ ........ Alteration .......... .~.. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 5. If dwell rig, number of dwelling units ......... ~1t ............ Number of dwelling units on each floor ............................ If garag'!e, number of cars ....................................................................................................... : ..................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........... ' ................. 7. Dimens(ons of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height l ....................... Number of Stories ................................................................................................................. Dimensi'ons of same structure with alterations or additions: Front .................................... p, ear ............................ Depth .! ............................... Height ............................ Number of Stories ................................ 8. Dimens!onsi of entire new construction: Front ....... ~,.(21 ........................ Rear ..]LO ..................... Depth ....~i~ ............... HeightI .................... Number of Stories ~ ............................................................................................................. 9. Size of !lot: Front ............................ Rear .................................... Depth ................................ 10. Date of, Purchase ........................................................ Nome of Former Owner ........................................................ 1 1. Zone oi use district in which premises are situated ......... ~A~...~..I~..~ ......................................................................... 12. Does p~oposed construction violate, any zoning law, ordinance or regulation? ................... ~ .................................... Name ~f Architect ................... ., .................................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate cl~early and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, end show street names and indicate whether interilr or corner lot. / STATE OF h~EW YORK, ~ S ¢ ,/i' ,, COUNTY 01~ .~;~'0,],~ .............. J' '~'/' ~. ..................... ) ....... ~,.~,,,/, ................................. being duly sworn~ deposes and says that he is the (~ame of individual signing application)' above name~. He is the ................. O~.]~. ....................................................................................................... ' k (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorize~to perform or have performed the said work and to make this application; that all statements contained'in~; this application are true to the best of his knowledge and t~ot the wore w be performed n the manner,.set forth in the application' filed therewith. Sworn ta before me this , of ....................... ...... , / , <... Notary Publijc~,~,~ .... -.. 'Pi ~A~ION A, REGENT ~OTARY pUBLIC, State et Now York ~o, 52-3233120 Suffolk County ~pplican~