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Home My WebLink About3189-zFORM ~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. ¥. r!.EI~TIFII~ATE OIr QP. rI. UI:ANO¥ No. Z. 2.~ ..... Date ............. Qetobe~. · · · .~ .... , ls 66. THIS CERTIFIES that the building located at ~/~.. l~lail~ .~o~d ............. Street Map No.. ~ ....... Block No ..... :l~ .... Lot No. Xt~ .... l~eOOFl-~l~· .N,.~-, .......... conforms substantially to the App]icati,on for Building Permit heretof~ore filed in this office dated ......... Allgl~st.--~(~.., 1966- pursuant to which Building Permit No.. '3~ .i~ dated ......... Al~gl:l~'..1.~.-., 1966-, was issued, and conforms to all of the require- me.nts .of the .applicable provisions of the law. The .OlCCupancy ~or which this certificate is issued is . F.&r~l .bll5,].c~i~l§ .... st~>~age ............................................... The certificate is issued to .. ~'$. ~l~.t~l~. ~ar,2 .~;~ ............. 0I~el'. ........... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ....... N.,I~, ............................. Building Inspector FO~M[ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERICS OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST I~E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK'AUTHORIZED) N? 3189 Z Oate .:.,..:..., ....... : ........ a~a.~.;....:ta ......... , lS6.6 .... Permission is hereby granted fo: · ...~-~gtte.: .................. ~ ...... :........ ............ ~ ...... pursuant to application dated ........................ tt,~a,~e,~ ....... .~.O ........... 19~:)4~.,., and approved by the Building Inspector Fee $ ~ ~. ~.t.'). ....... ; ...... Building Inspector FO~M NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. Approved ........................................ , 1~) ........ Permit No .... ~ ................... .......................... ................................. APPLICATION FOR BUILDING PERMIT 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 Deportment 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 agrees to comply with all appllcable laws, ordinance~ building code and regulations. ....... ...................... //~nature of applicant, or name, if a corporation) ........ ........................... 0~dress of applicant) State whether~applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nameofownerofpremises ~'~-~ ~~ ~ If applicant is a corporate, signature of duly-authorized officer. 1. Location of land on which proposed work will be done..Map No.: .../~.. .......... :.~.~ .................. Lot No.: ........................ Street and Number ..J~,~L..~2~.~,...I.~..,~L~'. ........................................ ]...~~ ...................................... Municipality 2.State existing use and occupancy of/g~d intended ~us/~/an/~)occupancy of proposed construction: a. Existing use and occupancy ....~-~'~/'/~'"~'~ ................- -~~~ /.)k.J ~L ....................................... 4. 5. 6. Natt~re of work (check which applicable): New Building .................. Addition ...~.. ......... Alteration ............... Rep( ir .................. ,~moval ..................Demolition .................. Other Work (Describe) ..................................... Estir ~ated Cost .......... ~....~. ...... .~.....I......r-x?~ ................ Fee ....................................................................................... ,, (to be paid on filing this application) If d~/ellmg, number of dwelling units ............................ Number of dwelling units on each floor ........................ If g~rage, number of cars ......................................................................................................................................... If b,'usmess, commercial or mixed occupancy, specify nature and extent of each type of use ....................... Dim',ensions of existing structures, if any: Front ...... ~..~.. ..........Rear . ....... ..~.....~t~.... ......... Depth 9. 10. 11. 12. 13. , , ! Hei~lht ..... '.,~......~. .......... Number of Stories ........... :..::.; ......................... Dim,,'ensions of same structure with alterations or additions: Front ..... Depih .......... ~ ..............Height ......~,~...~. ........ Number of Stori Din Size Dot Zor Do~ Na~ ensions of entire new construction: Front .................................... ht .................... Number of Stories .............................................. of lot: Front .....k~,..~...~ ....... Rear ..~~...~'-Depth of Purchase ........... ~ ....................................... Name of Farine or use district in which premises are situated ../..~.....~.,. proposed construction iolate a~ ' ne of Owner of premis Nmge of Architect ...... ~..~ ............ ='""/h .................... Address Nar ~e of Contractor ~.~..~....:.....Address PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed nes. Give street and block number or descri occordir Locat property J whether in ~erJor or corner lot. STATE O~ NEW YORK, ......... ,~,,,-~<.,..'tc,..m.......k,.~.,~,~,~,~,'~....~r:~..,. .................................. being duly swo~ (Name of individual signing application) abow,~ na~ed. He is the of said m,ner or owners, and is duly authorized to perform or have perle this applJ,:ation; that all statements contained in this application are true that the ~ ark wiJl be performed in the manner set forth in the applicati Sworn to ,efore me this ............... .: ........ day of ............................................ , 19 Notary PLjblic, . ........................................................... County / ar ............................ Depth ................... l..,b,,,,~.: Phone No. Phone No. f~hone No, and indicate all set-back dimensions fr and show street names and indic deposes and says that he is the applic :tar, agent, corporate officer, etc.) the said work and to make and best of his knowledge and belief; therewith. (Signature of applicant)