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Home My WebLink About3967-zTOWN OF SOUTHOLD RUILDING DEPARTMENT TOWN CLERK'S OFFICE SOO'I't/OLD, N. Y. P.E:RTIFIP. ATE: OF OP.P. UPANCY THIS CERTIFIES that the building located at $/$..~or~ .D~.~,VO. ........... Street Map No..~l.a~$.oy~ .... Block No ............. Lot No..(~.lltcho~ue,. I~..YO~]g ......... conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ...... .~.u..ly....2.2., ....... , 19.6.1~. pursuant to which Building Permit No. 3.967. dated ...... .~.u.~.y....2.2., ....... , 19. fi.8., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The ~occupancy for which this certificate is issued is . p.r..~.v.a..t.e...oDe...f..aka. ~.l,y..¢]W .eJ, l,;l. lag..WSth .garafl[~..(ac~g.c:$~.o~Y. The certificate is issued t.o ...~..(~..i.n...A.o...S.m.~.t.h. ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... /.~ J... I:. ~ ......................... ......... ..... , ........... / ........ Building Inspector FOI{M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE COMPLETION OF THE WORK AUTHORIZED), UNTIL FULL N? 3967 Z Do~e ............ , .............. ~ ...... ..~..~.. ...... , 19..~.... Permission is hereby gronliT~d t.,~,:.~....~..~...~,,~,,. ......... ot premises located at ~e~ ~. ~ , . . ................................. .~.~.~ ....... .....t~.,~ ................... ,....~ ......................................................... pursuan¢ to application dated ............................ .~..~ ......... ';~......., 19...~., and approved by the Building Inspector. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,nad ................ ~... ,9...~..? .~ ? ~ ? ~' Approved 19 t~ Permit No. D~sapproved a/c .......... .....,,,,,~.~:...~~~.:..:__~ '--~ ..... (Building Inspecto¥) APPLICATION FOR BUILDING PERMIT Data ..... ~...~. .................................. , INSTRUCTIONS a. This application must be completely filled in by typewriter or in iqk 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 ~ 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ¥<prk, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or f,6r removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing codetwen~ regulations. I r. ..... ~,,~..,.~....~,~. ..... ~ ............. (Signature of applicant, or nom~r~n) ........ .... / (Address of applicant) State whether applicon~wner, lessee, agent, architect, e:~ineer, general contractor, electrician, plumber or builder. .................................. ~~~ ......................................................... ......................................................................... ~o~o o~ o~o, ~,~ ..... ~~ ............. ~ .................................................................................. I{ opplicant is ~ corporote, si~noturo o{ duty ~uthorized officor. (~ome ~nd title o{ corporate officer) ~' ~o~ o~ ...... ~/~:......~t.~,.....~......z......~~~ .................... Municipofity 2. Stoto existino use ond occupancy o{ premises ond intended ~nd~ occuponc~ o{ proposed construction: a. Ex~stmg use and occupancy ......... ~L~ ...... ~. .......................................................... ............ ................. : ......................................................................... 3. Nature of work (check which applicable): New Building ..... .~-. ......... Addition .................. Alteration .................. Repair .................. Rem~yal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............ ..~......~..~..0..~ ........................... Fee // (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 .......................... ; .~..~...d....../,~:) ....................................................................................... 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 .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ Name of Architect ...................... ................................ Address ............... ; ............................ Phone No ..... ..~'.T:;.::.:..'~ Name of Contractor ~.~..~./XT.J.g....~..}(.~..~...~.~. ......... Address~.~.'r~.~.Z~..~q.~.£g[¢t'~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 lat. ......4~.~.'.~-(K~&,,....~,.~...:~J.~,~:.~../.~.. .................. ' ........ being duly sworn, deposes and says that he is the applicant (Name of individual~i~ap~ation) ' above named. He is the ......... ~~:~ ........................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is dul~authorlzed 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 .......... of ...... //r / , ......................... Notary Public, ~.(..l~...L.~:.,..[.~~ounty (Signature of Te~ ~es ~arcl~