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Home My WebLink About3552-zFOR~ 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. OERTIFIOATE: OF OOIgUPANOY THIS CERTIFIES that the building located Jat . .lg/.t~...Hlavla~JaA~..Pa.~;h .... Street ~ap ~o.X:~ ........ ~loe~ :~o...~r~x ...... Lo~ ~o...~ .... ~..O.U.*,..hp.~.4.,...~.~%: ........ conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated .......... ,II:[].y...2D ..... 196.~.. pursuant to which Building Permit No..3,~.~.2~. dated .............. ,llLly...2fJ., 19.~., was issued, and conforms to alt of the require- ments ,of the .applicable provisions of the law. Tile .occupancy f, or which this certificate is issued is .P.~.iT~,+~e..~X~e..famil7 .d~.~ollir~'~. ' . ......................... The certificate is issued ~o . .~.9.~.h...'.e.q.k ............. ~.~ ........................ (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Appr,oval : ~.~rt... 'l ~.,..'1.~6~... b~g. ~1..~. ~&l][tl ..... ", 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? 3552 Z Permission is hereby granted to: ................. ~..~.,..,....~.. ~..c...~..o..,..?~ ........................ ~.?....~e....c...o.~.. ~ ..... ............................. .~L.~.:.~..-. ................... to ....~....~...~.e..~...~.. ~...~.~...:~..s~. ................................................................................... at premises located at .~.I~....~....}~,...~1...?..~...~.. ........................................................................................ ........................................... ...~..~...o.~.4.~...~.:.~.,. ................................................................................... pursuan,t ,o application dated ................................. ~.~. .......~....., 19..~...., and approved by the Building Inspector. Fee $..~..0...,.~ ........... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH JAN Da~e Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give dee~ location) have been inspected by this department and found to be satisfactory. District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. APPLICATION FOR BUILDING PERMIT Dat .................. ....... , ...... 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 tot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detai~ed description of ~ayout 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 a Building Permit to the applicant. Such permit shall be kept on the premises ova'doNe for inspection throughot~t 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 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 COmrply with all applicable laws, ordnances and regulations. ,~ /_ ....... ($1gnatu.re of applicant, or name, if o corporati~n)~ .......... (Address of applic~;~) Stat~ whether applicant is owner, lessee, agent, archffect, engineer, general c~ract?r, electrician, plumber or builder. applicant is a corporate, signature of du~; authorized officer. , , (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ..~/%_.,'.~...~.~"kot No' ~/ ~' ... '~'x/._... ~ ~ c'~. _,_--.c,:x.~ ' ..... ~-'~?'~ .......... ;; ................. Street and Number ..... ~~.......,..-~;;;;f&i.~;ii¢6...~.~~._ ....................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. I ntendeduseandoccupancy t . ..'~.....c~..?~..?~..~l ...... ~..:~~ ...................................... 3. Na¢~Jre of work (check which applicable): New Building .................. Addition .................. Alteration .............. Rep~ r .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Esti:mated Cost ....../.~.~..~ ................................. Fee ...................................................................................... (to be paid on filing this application) 5. If d,welling, number of dwelling nits /' Number of dwelling units on each floor .....~.. !f g6. rage, number of cars ......................................................................................................................................... b~usiness, commercial or mixed occupancy, specify nature.and extent of each type of use ............................ 6. If 7. Dim$ensions of existing structures, if any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ......................................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ............................ De)th ............................ Height ....................... .~ ...... Number of Stories ........................................ 8. Dim msions of entire new construction Front....~....~.~, ................. Rear ..~.~.?....~. Depth ...'~ Hei ht ..... ~....O. ............... Number of Stories.....~ .................... '~F.~,,.,-- ~'~'~/c~ .,JL,~e--,.~-~'2N'~'i/ 9. Size of lot: Front ......./..O..:..-~... ............ Rear ...... /._~....-~.... ........ Depth ......... ~..~.~......,~... ............... 10. Dat~. of Purchase ....~..~,..~.,.....~....'~... ............. Name of Former Owner ..~..~.. 11. Zon e or use district in which premises are situated ...................................................... 12.' Doe~ proposed constructiont yl~lat, fe~ny z~ning [aw, ordinance or regulation? ...... ~ .................................. 1 3. Nar~e of Owner of I~rernises ~' .Ik.~. ~.~. Address ............. Phone No ' .............................. Nar~e of Architect '_.~. ...... Address ...~~ ............. Phone No ................. Nar~e of Contractor ..~Q~'~"~- Address p~,~,~ PLOT DIAGRAM LocateI clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lipes. Give street and block numbers or description according to deed, and show street names and indic~ whether interior or corner lot. STATE OFj NEWt,,-~(~,, ~ ~ ) c, ct COUNTY OF y,.-"~¢~,-~t..,),,,,,';4 ~ , /, , ':. . (~ome of individual sig~5?~otion) above nam:ed. He is the ............. ~~ ........................................... ' ............................................ (Contractor, agent, corporate officer, etc.) of said owfler or owners, and is duly authorized to perform or have performed the said work and to make and this apphcahon; that all statements, contamed in this application are true to the best of his and and that the work wdl be performed in the set forth i~ ~lication filed Sworn to of Notary PuI~lic, (Signature of applicant) TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............................., 1c) ........ Approvea ........................... ~ ........ ~ ~ ................................. Disapproved a/c ......... ~, ...... ~......,~.~.~: ~=..'Tg. ........... .~ ....... ~'~. ....... ~ .................· (Bu~h~ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submi~ed 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 ~nspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout'the ffrogress 'of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a 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 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, ora~il~ances and regulatio;,~ ~j~ ....... (Si,gnature of applicant, o..r name, if a corporatJon[,/~ ................................ ............................... State whether applicant is owner, lessee, agent, architect, engineer, general c¢~rz, ar.~r, electrician, plumber or builder. .................... Z'""Ziii ........... ............................... ........................................ ,? Name of ow p ' . ......... ~ ........ ~ ..................................................................................................................... If applicant is a corporate, signature of duly authorized officer, (Name and title of corporate officer) Street ond Number ....................................................................................................................................................... Municipality 2. Sta~e existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occuponcy ............................................ ~ ............................... :.,~ ................................................ b. Intended use and occupancy ......................................~h .................... · ........... .~.. ........................................... 3. Naa,ute of work (check which applicable) New Bu ding ................ Addition .................. Alteration .............. eppir .................... Rern~val~, .................. Demolition .................... Other Work (Describe) ........................ Est ~--~ed" -~ /'~' '~' ~ ~ (to be paid on filing this application) ............................... Number of dwelling units on each floor ...~ ................ 5. If d~elling, number of dwelling~nits / If g~rage, number of cars ......................................................................................................................................... 6. If ~usiness, com~rcial or mixed occupancy, specify nature,and extent of each type of use ............................ 7. Dimensions of exis}ing struct6res, if aha: Front .......... ................ Rear .......................... Depth ~ Height ............................ Number of Stories .',...' ...................................... : ............................................................. Dimensions of same structure with alterations or additions: Frgnt ........ : ....................... Rear .......................... , Depth ............................ Height ...................... ~ .... Number of Star es . , .................... ~ 8. D m~nsonsofentrenewconstructon: F~ont...~,~ ............. Rea~.~J Death ~ ~ , . '. o " ~e~ht ............................ Nu~er at btorJes ................................. ~ 9. S zeJof lot' Front /O ~ Rear / ~ ~ Depth / ~ ~ ]0. Dat~ofP~rchase".V;'~"~''~', ~'"'~ ........ ~'~'~f Form~7'~;"'"'~ ~~ 11. Zon~ 'or use district in which premises are Situated .......... : ........................................, ~ ........ , .......................... 12. Does, proposed construction vi~at~:n~ng law, ordinance or regulation? ....' ................................................ 13. Nam'lc of Owner of ~ises ....~.....',~..~.]~: ............. Address ....~.~ .......... Phone No ................... Nam~ of Architect .:....~..~ .... Address ............ Phone No iName o ~ontractor . Address .............. Phnn- Nn ' 'PLOT DIAG~,M kocatel clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frol property lines. Give street and block numbers or description according to deed, and show street names and indical whether interior or corner lot ) STATE OF NEWCY~..~/ ) ~ ~ (N~me of individual si~.n~ ~p~lic~tion) .' above named[' He is the ............ ~~7~ ................................................................................................ (Contractor, (]gent, corpomte officer, etc.) o~ said owne~ or owners, and is duly authorized to perform or have performed the said work and to make and file this applicatibn; that all statements contained in this application are true to the best of his knowle~ and belief; and that the [work will be performed in the m~n~er set ,forth ~plication filed therew t~, / ~ Sworn t0 Wefore me this ~x' , x~ , ~ ~ ~ F~ ~ ( ] ............. .... ................ Notary Fubliq~~:~?~~County~ (Signature of opplicant~ ~