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HomeMy WebLinkAbout3459-zFOI~ ~o. 4 TOWN OF SOUTh{OLD BUILDING DEPARTMEI~T %'OWN CLERK'S OFFICE $OUTI-IOLD, N. ¥. I~I~RTIFIOATt~ OF OOOUF~AN~¥ No...~..3.0.~.4... Date ... *%P~.:[,1..4., .................. 19.68. THIS CERTIFIES that the building located at ~.9.$./~01%~0~..~r~e .......... Street Map No ............. Block No ............. Lot No.. J~.Otl.~hOld,. Lo]t,,. I~,Y.. ........ conforms substantially to the Applicati~on for Building Permit heretof, are filed in this office dated ..... ~p~.tl. J~9 .......... ]9.6?. pursuant to which Building Permit dated ..... ~y..~ .............. 196.7.., 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.~..:L.V.~..t:.e...o.n.~...~.~;~.~,1~'..d~l:ln~[ ........................................ The certificate is issued t~o ....... Rob$~r.~ .A, .DO~...Ow~e~ ........................... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health App,,oval ....... /..V..:..~: ....................... Building Inspector / FORM NO. i TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MU,ST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AU'I:HORIZED) N? 3459 Z Permission is hereby gronfed tO: .......... ,~.~....~.~t....~.~e~..~.~ l~s~ ................. .~.~.~.~ ......................................... at premises located at .';W/$.-.,,JJtD~Ft~D~..]~ ......... ;'"T ....... ; ............................ ;"]'? ............................... .............................. ; ...................... 8~t~t~'-.--lt.,~.,. .............................. .-.:. ...... ; ......... : ....... : ........... pursu~n¢ to application dated ......... : ..................... ~ ...... '2 ....... t:'", 19..,~,. and approved by the -l~uilding Inspector. ' , ; ,, . Fee, $. ~tr~)';,'"~ ....... ' Building InSpector-' FORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. I:xamined ...~...~... ~ ~7 ~f 19....~.... Permit No. ,.~..~...~..~ Approved ........................................ , Applicmion No. (Building Inspec[~(r) APPLICATION FOR BUILDING PERMIT Date Z//-,~7 ~ 19.~/~.. 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 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 p~rt of this application. c. The work covered by this application may not be commenced before issuence 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 shell 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 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 end regulatig, ns. / ~) /' (Signature of applicant, or name, if a corporation) ~/' T ~ /~"~ ~ ~),~..,/~ C~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer,~general contractor, electrician, plumber or builder. ................ ........ :. ./. .... ...................................................... Nome of owner of premises ........ ~..'~.~(~.. ........................................................................................................................... If applicant is a c~oo,~ote,,~ignature~f duly authorized officer. ........................... (Name and title of corporate officer) Location of lend on which proposed work will be done. Mop No.: ...................... L.._~_.~.~:~,,~ ..................... Street and Number ............. ./...~'..~......./~.....~ ............... ~.~'..~..~/~T~'.. ......................... Municipality b ,nte:fat er:i:nd `tis tnedUse nd occu '~ gu s~'~ ::adh doc cOcucpuanc ?cnyc '~' '~:'' ~' r..~'41~~ ~~.~ .~ ~.. ~i.~.~..~r..~ .~..O1.' .ed...~ .~ .~il.r..~i.t.'.~.~: · p ¥ ......... .,,,. ~,~.~. ~ ..................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition ....~ ..... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........... ..~....'~.~....~...~.....~ ............... 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, specifX nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ....... .~'...~.. ............. Rear ......... ~...~... ................ Depth .........'~...Y~.. ...... Height ....... ~.~-..'. ......... Number of Stories ........ .~-... ................................................................................................... Dimensions of same structure with alterations or additions: Front .......... ~.','~.,~.~,~. ........... Rear ....~.~...,~.....~.. ......... Depth ...... ~..~.,.~.~: ............ Height .....~'..~....~.....~=. .......... Number of Stories ....... ~. ...................... 8. Dimensions of entire new construction: Front ...... ~'~.~-., ................. Rear ....~.~.~..~.~. ........... Depth ....~.~..~.. ..... Height .,_9..~_~.... Number of Stories ....... ./. ............................................................................................................. 9. Size of lot: Front ..../~.#.....~.-~.. .......... Rear ........ /..~..~.....-~... ............. Depth ...... .~..~..~.....-.'~.. .......... 10. Dote of Purchase ........................................................ Name of Former Owner .......... ..-('.<9~_.. ................................. 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation.;) ...... ~..~ ............................................... 13. Name of Owner of premises ...... .~..~....'~.....'~... .................. Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........ .'~x~-'..-.- ..~-.'.....;-~./.~...z::........Address ....~..~......~...'./...'~...~...~..?~,~......'~/..~-Phone No..G~..~...~...T../.~.~.? 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, end show street names and indicate whether interior or corner lot. STATE OF NEWZCI~,j_~ ISS '~ ~'/ ~ -- .......................... ~....~;~ ............. .b~e~n'~g ~uly sw;rn, d~~ay~;is' the applicant (N~ ,ndi~ual signing o~ion~/ above name~e is the ...................... ~.~.~ . ........................................................ (Contractor, agent, corporate officer, e~c.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke 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 fo~h in the application filed therewith. Swam to before me this ~ ~ /) ~ ..................... ..... ................ , U .............................