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Home My WebLink About3773-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT ~/'OWN CLERK'S OFFICE SOUTHOLD, N. Y. No...Z. 3371.. Date ....... D..~.~.~1%..~.7.,. ........ 196.8. THIS CERTIFIES that the building located at . .]~ay'. AvellllO ................ Street Map No..7.7.0 ....... Block No ............. Lot No..2..~...14~t;~gJ,~;U~,~,. ]~..¥0~1~ .... conforms substantially to the Applieati,on for Building Permit heretoSo.re filed in this office dated ..... .F.e.~.l~ltlll~]/'... ~.9., .... 19611. pu.rsuant to which Building Permit No3773. ~.... dated .... .F. 0~.I~llt~tl~y...2J.., ..... 19.68, was issued, and conforms to all of the require- ments ,of the .applicable 15rovisions of the law. The .occupancy f. or which this certificate is issued is .. ~X~L.v. at~ .gOX&g.e. & .$~:~Na.~e. mhe. d..(acc.e, ss.o.2ry. Jo~;J, ld;J,L~g) ........... The certificate is issued to . .JO.s. ePh.D.o..~ .q~.%~.t.$1%e..I~.o...l:I~e. cj .................... (owner, lessee or tenant) of the aforesaid building. ., .Suffolk County Department of Health Appr~oval ......................................... Building Inspector ! FORM NO. ~ TOW~ OF SOfT'OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N-° 3773~ Z Permission is hereby granted to: BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ..................... ~..~)~ ..................................... to ..lt~g.~1..~ .a~L~l £tte~..~..a~ ..~es~"~..~,~[~ ~. ................. ; ........... ~.. .................. at premises located a~Jll~.~..J~'~,.~i,~,..~JO ......... J~..,~.~..~JL,,~Jo~l~te.~.~L~.,~.~. ..................... ......................................... ~l~t~LtU~k, .... ~.~ ,, ................................................. : .............................. pursuan~ to application dated ..... i ............................... ~J~.~.....~[~...,, 19..l~J~., and approved by the Building Inspector. ~ee ~..'.~ ............... Building inspector ~/ FO]~,M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×omined .............. , Approved ................ ~.~. .................... , 19.....~.!. Permit NO ............................. (Building Inspirer) APPLICATION FOP. BI, II[DING PEP`MIT ....... d ................... , .... 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 shewing location of lot end of buildings on premises, relationship to edjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is port of this oppllcotion. 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 port for any purpose whatever until o 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 Lows, 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 lows, ordina,~es, building code, I~ousing code, o:nd regulations. to ......... .............................................. ~ (Signature of opplican~ or name, if a corporation) .... ""'" ...... "~"' '"'"" ......... (Address'""'"'"'"'"'"'"'"'"x'"'"'"'~'"'"'""'""of oppncont) Name of owner of premises ........ ~ ................. : ................................................ ' ......................................................................... 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.: .....~...~....~.. ........................ Lot No.: ....~..~.. ............. Street and Number .................... ~. ............... ....,...~..~..]~/...'~.~.-....,.7..-......~. : ............................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~'~,q ~....A...~..~ ....................................................................................................... b. Intended use and occupancy ....... ~.fi~.~.......~...~.~.....~.Z.~...~.?...G.'..'.~.. ........................................................................... 3. Nature of (check which applicable): New Building .................. Addition ~/ Alteration (to be paid on filing this application) 5. If dwelling, of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, ~ber of cars ....... ~...~..' ............................................................................................................................... 6. If business, :ommercial or mixed occupancy, specify nature and extent of each type of use ......T... ........ ' .......... Height Number of Stories .... .~ .,~...~..~'. ........................................................................................ ' .......... Dimensions ame structure with a.lter~-ions-or additions: Front .... ..~.'..~. ........................ Rear ...~. ~../........' .......... Depth ................... Height ............................ Number of Stories ...... .'~'"~"'~/ ................ /,~ tf Height Number of Stories OA/g' L 11. 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 .......... ~ .......... Name of Contractor .................................................... Address ............................................ Phone No .......... ; .......... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ell 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. i'~d//~ZZ~ ?L. 5,¢/F l~rx:'~~ zg, r ~ .... ;'i ............... ' ' ' : ~{~ / .... ...... ................................................ [Name of individubJ signing application) above named. He is the (Contractor, agent, corporate officer, etc.) ~¢~~ and is duly ~uthorized to per~orm or have performed fha 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. ...... .......... ...... ........... ~ -, , ", ,~"r.~