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Home My WebLink About3927-z FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) i Permission is hereby granted to: ~ ........................................ ~t~cl~....J~,~, ....................................... ~. ........................................... pursuant to application doted ............................ ~l~JlJ..,i,.,..~.,i....., ]9..~., and approved by the ;Building Inspector. ~ui ding inspector FORM ?OWI~' OF SOUTHOLD ~-UILDI~G 'I"OWI~ CLERK'S OFFICE SOUTHOLD, 1~, OERTIFIOATE OF oor-UpANOY No...Z..3.3..~.7... Date .... .D?, .~.e..r~...e.~....~.7., .......... , 19.6.~.. THIS CERTIFIES that the building located at lq../.~..~.o.~.U.d' .V;~.e.W..~y..e, ....... Street Map No ............. Block No ............. Lot No....~Q~I.t~O~..~,. ;~..YO~.~ ......... conforms substantially to the Applicati, on for Building Permit heretof, o.re filed in this office dated .......... ~.~..~.~. ....2.].. ,.., 19.6.~.. pursuant to which Building Permit No~9~.7.. 2... dated .......... .O'.U.n..e .... .2.],.~.., 19.~.~., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The occupancy f.or which this certificate is issued is .... p.lc.i.V..~.~.e...o.r~e..~u1~lly .~].l. in~ ....... , ............................... The certificate is issued t,o .... ~..:1..~.i~...~.~..~..~.~.~.~t ..... ! ............................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......................................... Approved ........................................ , 19 ........ Permit No ..... I~R~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPART~ENT~ TOWN CLERK'S OFFICE SGUTHOLD, N. Y. Application No ..... ,~..~...~,...,~....~ ...... APPLICATION FOR BUILDING PERMIT Dote ..... ................... ~ .............. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in i~k and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, reloti0nship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown qn the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Building inspector will issue ~ 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 pu!pose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION 1S HEREBY MADE to the Building Department for the is~suance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~rk, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or f~r removal Or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, buildihg code, housing code, and regulations. (Signatur of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, a~rchite~t, engineer, g~nerol contractor, electrician, plumber or builder. Name of owner of premises ..... l~.~....~.....~.. ....... ~~~..-~.. 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 N~g~: ...... i.......~.. ....... : ............... Lot No~,,~......~. Street and Number ......... ~: ........ ~~......~..~..~.;;.:.; ........ ~~~.~ ........ Munici~lity 2. 5tare existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and p cy .................................................................................................................................. b. Intended use ~nd occuponc~ ............ ~ ............................................... 3. Nature of work (check which applicable): New Building ....... ~ ....... Addition .................. Alteration .................. Repair .................. Removal ..................Demolition .................. Other Work (Describe) ........................................ ~J) ,,~,-r~ '~ Fee I'O~ . . 4. Estimated Cost ..... ~/.M..~.ff ........................................... z.; ................................................................................. (to be paid on filing this application) ,5. If dwelling, number of dwelling units ........ ~ ........ 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 ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ................. ....... Number of Stories ................................................................................................................. Dimensions of same structure with a.lterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~...(,~ ...................... Rear ..... ~....~. .............. Depth .../...~........'~....~..... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front .......... .~.~. ......... Rear ....... ~./-.....0'~. .................... Depth .....~.....t:..O. .................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] 1, Zone or use district in which premises ore situated ....... .~'~ ........ ~ ............................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ........... ~ ......................................... 13. Name of Owner of premises ~..~../..~.~.~.~.~.~/~AddressS.~¥~j..~y.~5~%~.~.~.. ......... Phone No ..................... Name of Architect ..... .,~ .............................................. Address Phone No ..................... Name of Contractor ..(.~...~..~...Address i'.iiii~]iiii'.iiiiii Phone No.).~?.Z...?..?.~r PLOT DIAGRAM i_ocate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back property lines. Give street and block number or description according to deed, and show street nome whether interior or corner lot. limensions from and (ndic¢ ¢ STATE OF NEVi,~¥ORJ~.,.~ COUNTY OF .~.q.,.]-.,"~.. ...... ..~..~. ~~~ b~ d~y ~o~, depo~e~ ~d sw~ th~ h~ i~ th~ ~p¢~c~t (Name of individual signin~pplicafion$ ' '~']~"~'~'~;."~e is the ~J~¢)~.!~~~.~'~{~~ .............................. ~ ...................................... ~ (Contractor, agent, corpora e 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 ib the application filed therewith. Sworn to before me this ................. o, ........... ............ ............... ........................ NOTARY ~UBLIC, State of New .~33120 Suffolk Co, Noj~ ~ires ~rch 3o,