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Home My WebLink About3977-zFOEM l~O. 4 'rowl~ or so~rraoLo BUILDING DEPARTMEI~ 'I"OWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIP-ATE OF OOr. UPANO¥ No...Z...~.3,~.6.,. Date .... I~cem~.e3:..-~?, ........... 196~. THIS CERTIFIES that the building located at O~e0. RYe .................... Street Map No.. ~7 ....... Block No ............. Lot No..$~t~ld,..~$. ~O~ .......... conforms substantially to the ~pplicati,on for Building P~rmit heretofore filed in this office dated ....... ~. ~.Q, ........ 19~.B. p~rsuant to whiCh Building Permit No39~.~ .~... dated ....... ~$~ .3~., ......... 1~$.., 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 .. ~!~..0~. ~.~..~e~l~, ~i~. ~di~iO~ ...................... The certificate is issued t,o ..... ~8. ~ ....... : ................................ (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......... ................................ Building Inspector FORM NO. 2 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? 3977 Z Permission is hereby granted to: i: ~..~...:~/.~....~..~:~ ............ h premises located at ............ .{JjJ~. ~J;~lJ.......~ ............ (,~h:;~l~..~li.t;l~.JJ,) .......................... ................................. ~t~3.a~..]i.,.~..: ................... ~ ........... ! ......................................................... pur,suaz~t to application dated ............................... ~..~jJ.....~.!.....,, 19...~, and approved ~by the BuiJ~ing Inspector. .................. Building Inspector ~J' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ^~d ............................... : ........ , l~ ........ 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 pi.an showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giwng a detailed description of layout of property must be drawn on the diagram which is port of this appl cot on. 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 appli~:ant. 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPL C.~TION S 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 Ragu at onS, 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 ragu arians. ,, ~9 (SigrAa~tur. e~ .qf appllcan~7 or name, if a corporation) ...... ............................................. ' /(Address of applicant) State whether appllcant is owner, lessee, agent, architect, engi.n(eer, general contractor, electrician, plumber or builder. ....................................................................... ......................................................... Name of owner of premiSes .....~... ....... ~......~... ................ ..~.....~.....~.-...~-.~......~.....~. ............................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy d..,~'~ 3. Nature of work (check which applicable): New Building .................. Addition ...~... .......Alteration .................. Repair .................. ,Remova . .. Demolition ................ Other Work (Describe) ........................... Est mated Cost ~'/~ ~ Z~ 9~' · ' .............. 4 ....... ~ ................. .~. .................... : ........... Fee ....... ~ ..................... (to be paid on filing this application) 5.If dwelling, number of dweJling units ...... J.i..' ............... Number of dwelling units on each floc~r ......... ./.. ................ If garage, number of cars. -- ~i If business, commercial or mixed occupancy, speci~ nature and extent of each type of use .......... ,~ ........... Dimensions of existing structures, if any: Front .~t..~.. .......... Rear ....~..~... ............... Depth ......,~.': ............ Height ...../..¢. .......... Number of Stories ................................................................................................................. Dimensions of same structure with alterations or add t OhS' Front ,2~, Rear ~.-" '/ Number of tl ................. 7 ......................................... Depth .....~....~.... ............... Height ..... ,.~.. .............. S aries ................................ 8. Dimensions of entire new construction: Front ......... ~....~... ............... Rear ...... ...~...~ .......... Depth ...l~... .......... Height Z.~.. Number of Star es 9. Size of lot: Front .....~...~..~'...~.. ..... Rear ......... ~'"~ .................... [~;~ ....... ~.~'~."~ .......................................... 10. Date ofPurchase..~..'.~....~...~. .......~....~.2121::::ii~"~;"Former'~ ~.~.'.'~'~~ 11. Zone or use district in which premises are situated 12. Does proposed construction violate any zon nn nw ord nonce or regular on;~ 13. Nome of Owner of premises ...~..~..~.~..~. ...... ~.~..'.' ...... Address ..~-.~.e~...,~.a.A-~ .......... Phone NZ~....-~... ................................................... · ............ Name of Architect .................................................... ~ ,^ddress ...~, ........................................ Phone No ..................... Name of Contractor ...~...~.~....~....~..~ ~.../~..~ddress ...~.~...~....~.....~..~ ..~...~....... Phone No.'~..~....~../~.~z~'.~.~ 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 occording to,~deecl, and show street names and indicate whether interior or comer lot. STATE OF NEW YORK, t S S COUNTY OF ............ ................. · ;~; ...... ~ ............. /...b~ing duly sworn, deposes and soys that he is the applicon! ~mome at indi~'idual signing application) above named. He is the ......................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to rnoke 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 tt~e manner set forth in the application filed therewith. Swam to before me this AtBE~