The URL can be used to link to this page

Home My WebLink About3199-zTOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OWN CLERK'S OFFICE SOUTHOLD. I~. Y. r:I~I~TII:'Ir:.AT£ Ol:' 13~I~UI~ANI~¥ No.~. 2.~6 ..... Date ............ THIS CERTIFIES that the building located at .]~'/'S.' .q2~.t{~lC. '~O ............ Street Map No.. Yt,Be]{If~ Block No...~ ...... Lot No..~'.Jl~ ..... g~l;~hogt~.e~. ~.,... conforms substantially to the Application for Building Permit heretoJ6ore filed in this office dated ............. A{;~g.. '2~'", 196~' pursuant to which Building Permit No..~],~ dated ............. AI~ .30 ..... 19.(~,j~, was issued, and conforms to all of the require- merits .of the applicable provisions of the law. The .o,ccupancy for which this certificate is issued is ...I~. ~2iV~ · O~l~..2a~]~y..a~oii.l~g ..... : .................................. The certificate is issued to ..~..]..~k~): .i~i~.eOig)ck ..... ~5~A~ ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Apl~roval .... ~. R, .............................. Building Inspector BUILDING PERMIT (THI~ PERMIT MUST BE KEPT ON THE PREMisEs UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted .... !t~a~I~..&V~ ........ ;., ......... :......,:....:.~ ...... ~.... .... ¢,~t~hoW~a,...~...~'~ .... ; .............. to ........... b~a,t,l~l.. ~r~ ..a~cltt~ion...t~..a,..o~.. ,~aa~ Ly... ~ ~n~ . .. .... ....................... pursuant to application dated ........... A~aa.~..-~!i- ............................ 19..6~., and approyed by the Building Inspector Fee $ ....... ~Si, 4;)0 ..... FORM NO. 1 Examined ......................................... 19 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............ ,~.. ...... ~ 9 ,~. Perm t No ............................... Disapproved a/c ........~.:...~ ......................... ~ .... ...................... ................................. 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 propertymust be drawn an 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 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 applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of pram.sas' ...~.~.../L~...~.....L.~./~...~'....OI.......~...i~ ~' ......................................................................................... 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: ...... l..~....?...~?.......~, ............... Lot No:..~.L.....'~....?...~ Street and Number ..~-../...~...~...~..~/..~..~..~Z~.~.~..c~..t.~.~...~.~..../d.~.?...~.~.A.~.~.~..~...~.~..~..~.'(~¢~ ................................................. Municipal'i~y ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: O.. a. Existing useandoccupancy ..... ....... ~.....~.i....,,..~..~...*....~... ,~-.....~.~...,/,~..,~..~.,~..~....~i ................... b. Intended use and occupancy ........ ./('~...--~...~..../.Z..~.?/.......].~....~..~...~...4./,~./..i~....~ .................... 3. Nalure of work (check which applicable): New Building .................. Addition ..,..~... ........ Alteration RE air .................... R/~moval .................... Demolition .................... Other Work (Describe) 4. Esti'~ated Cost ......~......~..~...0...¢-~...:.....O....~ ........... Fee , (to be paid on filing this application) 5. If welling, number of dwelling units ............................ Number of dwelling units on each floor ....................... If arage, number of cars 6, If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ................... , ..... 7. Dir~ensions of existing structures, if any: Front ....,~....:..~.. ......... Rear ..,~.,~ ............... Depth Her~ght ............................ Number of Stones ............... Dim~ensions of same structure with alterations or aaditions: Front ....~,~.~ ..................... Rear De~th ,~..~...:.....~. ........ Height .............................. ~gmber of Stories ...... ~...~.:.~.. ................. 8. Din~ensions of entire new construction: Front ....,~./. ......... m ....Rear .....~.../.../. ........... Depth .../....~.....~.. ...... Height ........................ Number of Stories ........ ~.....'~..~.;.~ ...... 9. Size of lot: Front ..... /~..(,'~ ........... Rear ..../.f,').~2 ............... Depth ....../.....~../. ...... ~.._... ,~ , i ,, ///~,, / Name of Former Owner ....,~/:~..' ~'~ ..~ t~.~.. ~ 10. Date of Purchase ..... ~/././.~/.~,..): ............................ ............ .................. 11. Zone or use district in which premises are situated ...................................................................................... 12. Do~s proposed construction vio!a~te any zoning law, ordinance or,regulation? ....~....~ .................... .;; .......... ', . /-' 2~1/ ~ /I /./'^:-' , C ,~I /~ i~ 6 /~.Z,,~....../r~...6,./ /' Phone No.~..~.x¢~...~..,, 13. Na~e of Owner of premises ../.,~......¢.~.w..~.t~..~.....~¥~ddress ...... /..:.t. ........... Nakne of Architect ...................................................... Address ............................................ Phone No. Na,~e of Contractor .................................................... Address ............................................ Phone No. I PLOT DIAGRAM ~ocote clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions property liines. Give street and black numbers or description according to deed, and show street homes and whether i~terior or orner lot. STATE 0 COUNTY above na : NEW..YO~.,, U / S S OF ,..~.~..~..~.O.L/~ ......... I "} 2 ..~. ~,, ,,,, , ,~..,~.~, ,~, ,.,t~, .~ ....................... being iN~'n~-~"'~'~dividuol signing opplication) of said o, this appli and that Sworn to ibefore me this 19//~,.~.. ........ ...... ................... , ....... duly sworn, deposes and says that~he is the appli~ ~ed. He is the (Contractor, agent, corporate officer, etc.) mar or owners, and is duly authorized to pe~fbrm or have p~rformed the said work and to make and :orion; that all statements contained in, this application are true to the best of his knowledge and ~he work will be performed in the manner set forth in the application filed therewith. (Signature of applicant)