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Home My WebLink About3422-zTOWN OF SOtrrl-~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOo'rl-lOLD, N. Y. CERTI~'Ir-AT£ 0~' Or.r. LIF'ANCY THIS CERT~'L~q that the building located at J~i,n. R~d .................. Street Map No ............. Block No ............. Lot No...~m~ 4~.~On, · 1~..~Ogk ..... conforms subst~ti~ly ~ the Application for Building Permit heretof~e ffl~ ~ this office dated ... ~.~...~* .......... , 19. ~ p~suant to which Building Pemit No. ~2. Z. dated . ..~$~.. ~, .......... , 19..~7 was issued, and co~or~ to all of the require- men~ of the .applicable provisions of the ~w. The ~cupancy for which th~ co~i~te is issu~ is ....~Y~ · g.~g$..(~O~. ~$1.d~ J ............................. The ce~ificate is i~ued $o .... ~. ~ ........................................ (owner, lessee or tenant) of the ~or~aid building. ~,/ . [ ~, S~folk County Depa~ment of Health App~val ......................................... Building Ins~ctor [ TOWN OF SOUTHOLD BUILDIHG DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT CfHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~o. ~2 z ~ ....... ..~...~..../ .............. ,~,..(..? Permission is hereby granted to: ~ ~ ~0 ,o ..... ~..&.. ........ ~..~:~ ..... .~....~.~ ................................................ pursucr~t to application dated ............................. , 19. . Building Inspector. Fee $~.~ ...... NO. 1 Examined TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~ ~'~'' ~ Approved ........................................ , 19 ........ Permit No ................................. Disopproved a/c ............... 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 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 propertymust 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 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 Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of $outhold, 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 and regulations. '~i'~'r~atur~ of app~ if a corpo;~i~i ......... ~~ ~ ~/"C::~ ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........... ~....~ ........................................................................................ If applicant is o corpo, rote, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ............................................ Lot No: .................... Street and Number .......... ~.'J.~3~. ........................... ,. ............................. Municipality 2. State existing use end occupancy of p~emis~s and intended use and occupancy of proposed construction: a. Existing use and occupancy .................... ~;~ ........................................................................................ b. Intended use and occupancy ................................................................................... .~.. .......................... 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 dwefling 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 c~f Stories ............................................................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. H~ight .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ...... ~,:Z~..r ............. Rear ......~,~.~...............~ ' Depth .......~../... ............ Height ......... ./..'.~...~. .......... Number of Stories ..... .~'~,/4sm~ ........... Size of lot: Front ~ Rear Depth Date of Purchase ........................................................ Name of Former Owner ........................................................ Zone or use district in which premises are situated ................................................................................................. Does proposed construction violate any zoning law, ordinance or regulation? ...................................................... Name of Owner of premises ..~.,--~,..~-,~w~: ...... Address ........ ~,;~.~,.,~ ...... Phone No..~.,/ .... Name of Architect ...................................................... Address ............................ . ................ Phone No ..................... . Name of Contractor. ................ /..~ ............................... Address ............... e ........................... Pt~one No ..................... / PLOT DIAGRAM Locate ~i~learly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property liq/~s. Give street and block numbers or description according to deed, and show street names and indicate whether in,riot or comer lat. 10. 13. STATE OF NEWj:~'.OPyI~/) ,, ~ )~ ~ ~ COUNTY OF~,~;~' , , ~ .... ~. ~~.~ ............... ,.being duly sworn, deposes and says that he is the applicont above named.~~--~He is the .....C..,~..Z'l~.,~4.....~..'. (~4~..~.L~. ................................... .................. (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 cc~t.ained in this a.ppli.cation are true to the best of ..his knowledge and belief; and that the work will be performed in the manner set torth in the application filed therew,th. Sworn to before me this _ ,, -- 19..~..2 j#. ........................ Not°,,/,ub,,-, / ' S,gnat, re'of , p,cant