HomeMy WebLinkAbout3878-zTOWN OF SOUTNOLD
t~UILDING DEPARTMENT
·'OWN CLERK'S OFFICE
SOUTHOLD, N, Y.
No.. ~.3346..
Date .... ]D~Ce~K., 17, ........... 19.
THIS CERTIFIES that the building located atW/$. ~O:~ .I~1~ill ................ Street
Map :No ............. Block No ............. Lot No...~~,. ~..~ ........
conforms substantially to the Applicat~on for Building ~ermit heretofore filed in this office
dated ...... ~...~ .......... , 19~8. pu~rsuant to w~ich Building Permit No. 3~8. ~.
dated ...... ~...~ .......... , 19.68., was issued, apd conforms to all of the require-
ments .of the applicable provisions of the law. The .occUpancy ~or which this certificate is
issued is ,...multiple. xes.tdence.. (1~. ~p .~ra~s~ .......................
The certificate is issued ~o . .~e~. ~0~ .~a~V~ .X~. ................
(~wner, lessee or tenant)
Suffolk County Department of Health Approval ........ .................... , ..............
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 3878 Z
Permission is hereby gronted to:
............ ll~.t4~..~..~,~IX..~ .~..~.t..~.. Xm
at premises located at ....]II~/~....~J~'"L~I~I ........................................................................................
pursuant to application dated ............................. 1~' .......... ~1. ........... , 19...~, and approved by the
Building Inspector.
Fee $'""J'OilO~ ........
Examined ...... Z..F...:...'~Z...I. .......
Approved .................... ~.t..k. ................ , 19..!.!... Permit No. ~c~-~-- ~
,'~'~ ~- 7~y ~../~,
TOWN OF SOUTHOLD .2y~,-/~,c- i~,~,,.~
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No .............................
Disapproved a~.~...~ ...... '
APPLICATION FOR BUILDING PERMIT
Date .......................... ......... 2 .............. , i 9... .6..8. ....
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 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, housing code, and regulations.
Eastern Suffolk Cooperative Inc
(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.
........................................................ .............................................................................................................................
Name of owner of premises ...]~g.s.l;.e:r~..$.l~.o]J~...g.o~pe~.a.ti.v.e...T.n~ ......................................................................
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.: .,~4:~3; ............................... Lot No.: ..2r.~:~ ..............
Street and Number .....~./..~.......~...o..:$.....~..a...~..e. .......... g.~..~.~..h..o..E.~..~ ...................................................................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....... L0,]~.Q~...~,1~t:). ...................................................................................................
b. Intended use and occupancy ....... ~.D:.e...w.~..b..~..~.~..d.~.J~..~..~.(.~.~..~.~.~.?.~..~.~.~.~.e.~.~.~.~.~.~.~~.~ .........................
3. Nature of work (check which applicable): New Building .,,~.~.;C~C.... Addition .................. Altera.tion ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost ...1...1. a..0..0...0.....+---. ................................... Fee ..1...0..._.0..0. .............................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..... ~-Qtrte. ............. Number of dwelling units on each floor ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .....C.,e:.m.~. ..............
7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth ....................
Height ........................ Number of Stories .................................................................................................................
Dimensions of same structure with alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ....... ..~..0. ........................ Rear ........... .~..~. ............. Depth ....... ,~.2. ............
Height .................... Number of Stories ....O.~e ............................................................................................................
9. Size of lot: Front ............................ Rear .................................... Depth ................................
10. Date of Purchase ........................................................ Name of Former Owner ........................................................
11. ~'one or use district in which premises are situated ....~,.....~.~. ...............................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ..~t~ .....................................................
13. Nome of Owner of premises ..~..~..~..~.?...~..~....~ .~...~...'....?..O.~)dress ...... .71~.~..~..~..O..~.?. ................ Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ...... ..~.~ .................................... Address ............................................ Phone No .....................
PLOT DIAGRAM
Locate clearly 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, and show street names and indicate
whether interior or corner lot.
STATE OF NEW,YORK,
COUNTY OF ....~...~...~..6.~r~ ........... j~.~.
........................... ~,.,....?..~.~...~..~..e..~.::i:...c.~ ..................................... being duly sworn, deposes and says that he is the applicant
(Name of individual si~,ning application)
above named. He is the .......... ~.o..?..~....O..~.~..~.e..e..~ ..................................................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file
this application; that all statements contained in this application are true to the best of his knowledge and belief; and
that the work will be performed in the manner set forth in the application filed therewith.
Sworn to before me this
................. .c),.... day of .............
Notary Public, ~._/'.J.~...?...:...'.~ ............ County ~ (Signature of applicant)
~IARION ~. REGENT /J
N01'^RY PUBLIC, State o[ ~et,~
~10. 52-323312U St~ff0ik Cou
~mrm Expires f4arch 30,
!
,%.
APPROVE~3
, b ..... ., r'_,.F SANiTATiON
R~,,,,'~,,~, N, Y. :'.'Z .~.~."'~L,..
Ceiling 8' high of 5/8 sheetrock
6 Steel dooPs ~: casin~s 36" x 6~8" W/W 9,6" x 30"
12 Alum. windows (vent type) W/Screens
Closgt area 3sq. ft. per occupent
Forced Hot Heat
Comments: Selection and placing of heat registers,
material for closets, lldht fixt~r~s etc. is under'
study and plans 9~'e to ~hoose the - os~ dutiable fixtures
e~sily adaptable to sanitation