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Home My WebLink About3769-zFO~M ~0.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~OWI~ CI~Ei~K'S OFFICE SOUTHOLD, N, ¥. rI. EI~TIFI~ATI~' rIV OI~UPANEI¥ THIS CERTIFIES that the building located at~/.~..F~a!l~. ~O~ .............. Street Map No..Y,~ ........ Block No...XY~ ....... Lot No. y,0t.~;. · .0.~.eOlll~01~;~. .J~,.X., ..... ].. · conforms substantially to the Application for Building Permit hereto~5ore filed in this office dated .......... l~b~ ...... 12.., 19.6~ pm'suant to which Building Permit No..3.~.6~. dated ............ ~1~'" '~'~' ', 19'6~" was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy ~or which this certificate is issued is .. ]~ll~il~I~S · ~lll~{tlIl~ ...................................................... The certificate is issued t~o ...... ]L'I~O~;..I~-Ol~loe.l~ .1~t1~ ......... 0~lao~ ................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health App~;oval .... Iq.~R, ................................ 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? 3769 Z Permission is hereby gronted to: ............. .~.,.~..~.~..~ ............................ ..................... .~.~r.~ ..................................... to ~...~,..~6£t,~..~..~..~,;l.~zL~ .~e~..1~.:L~1.~ .......................... at premises located at ...i~.~. ...... ~i~,~..~.~ ......... (~.~.~ ............................................................... ......... ~.~~....~ .......................................................................... pursuan+ to application dated ......................... ~.G..~,. ....... ~. ............... , 19..-.~...., and approved by the Building Inspector. Fee $...~.~'~.(} ............ Building Inspector TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~...~ ........... , 19.. Approved ........................................ , 19.~,~..,.~Permit No ...... Disapproved a/c ............. ................................................................. .... ........... '.' ........ ....................... ( u'ldin~ Inspector) Application No. :~ 2 ~ ~ APPLICATION FOR BUILDING PERMIT INSTRUCTtONS 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 port 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 Departm.ent 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. ................................... (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 .......... .~t...~. ............... ..~...4~,. .............................................................................................. If app~nt is a corRorp~, signature of duly~authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................Lot No.: ........................ Street and Number ......................... ,..'~'...~..,~....~...~..~...~....,~..:.~.,~.. ..................................................... Municipality 2. State existing use and occupancy of premises and intended,u~e and occupancy of proposed construction: a. Existing use and occupancy .......... ~...~. :...~.. ~.'..~.:'.... · .-:~K...gr...~. r~.'.'.~..~...~.. ............................................................... b. Intended use and occupancy ................. "'~ "' .. . 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Olher Work (Describe) ........................................ 4. Estimated Cost ....... ~..?..o...~ ..................................... 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 ............................................................................................................................................. 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,lterotions or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number af Stories ................................ 8. Dimensions of entire new construction: Front ............ ..~...9..;z..~ .......... Rear............................ 9. Size of lot: Front ............................ Rear .............. ' ...................... Depth ................................ 10. Date of Purchase ............../..~.~...~ ............................ Nome of Former Owner ........................................................ 11. Zone or use district in which premises ore situated ,.../.~.~..~c~.~.~,~..~..~.~,~...~ .................................................. 12. Do'es proposed construction v/o/ate any.zoning law, ordinance or regulation? Name of Architect ...................................................... Address ............................................ Phone No ..........~ .......... Name of Contractor ...............~..C~/.'.~..: ........................ 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 nu~scription according to deed, and show street names and indicate whether interior or corner lot. I I j ~7 (Name of indi~dual signing,,~.,,.~.,_~,,,///apDlica~q9) /' , / , above named. He is the ....~...~X'.~.....~...~..~.......~..x(~..:.~.~..~..~./F./.~..~.~.../...Xfr~..(-~ .......................................................... r ........... (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 ~ // ~ , , /. '~ day of ~'..~c,c~4~ , 19 ~ /x/ ~/,,-~, , Note ...................... ry Public ~¢~...' ........... ~ ~~... County ~)'/"'-'~ ......................... 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