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Home My WebLink About9324-zI~OKM NO. & TOWN OF SOUTHOI,B BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificnte Of Occupnncy No. ~,~.t,).~.~.. Date ...... 0~C~.l ........ , 19.'~.) ~ap so. .~ ...... Block So. ~ ... ~ot ~o.. ~ ..... ~.~...p.,/. c~nfor~ substantially to the Application for Building Permit heretofore filed ~ t~ office dated ..... dated . ..~' .~'~..., 19.~' ~, was issued, ~d eonfoms to all of ~e requk~ ments of the applicable provisions of the law. The oceup~ey for which t~ ee~ificate The certificate is issued to .~.. ~(~~ . .. ~ ............ (owner, lessee or ~n~t) of the Moresaid b~lding. S~olk County Department of Health Approval . B, ~ ..................... v~vv~awaI,~as c~az~r~CA~ ~o..~ HOUSE ~MBER ~. ~ ~ Street ... ~,D. ~.~. .. B~d~g ~nspector FORM NO. 2 TOWN OF SOUTNOLD BUILDING DEPARTJ~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby gronted to: ..... · . ......... ~..~.....~..~ ....... ~.,..~.. ............................................................. ~;~ ............................................. ~.....; ............................. l..~,...~'i~i~ ,., - "~ - --~' '-~ "0 TOWN OF SOUTHOLD../~:~ ~ BUILDING DEPARTMENT ~,,~o,/v'7 ~ ~ ~ ~ ~ ~ ~ TOWN CLERK'S OFFICE,~' ' ' ~" ~ ......... ...... ............. ........................................ : ,,].z. ..................... ......................... ................................. (guildino In~pector) APPLICATION FOR BUILDING PERMIT Date ............. //._/._..,_... .................. INSTRUCTIONS a. Th~s application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildi[ Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship to adloining premises or pubhc streets. areas, and giving a detailed descriphon of layout ofproperty must be drawn on the diagram which Js part of th~s applicatio 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 Buddmg Permit to the applicant. Such pern shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupan, 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 t} Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The opphcant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. (Si~lnature of app/~nt, or name, if a corporation) .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or bufldF If apphcant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) Builder's license No ............................... .* ..................... Electrician's License No ................ 2..-~. ................... Othur Trade's License No ............................................... Location of land on which p~rop~osed work w~ill be .done AArp ~ ............................ Lot No ............... Street and Number ..... ..~/./...:.9... ...... ~......~.. ~'~.~ Municipality State existing use and occupancy of premises and intended use and occupan~cy of proposed construction' a Exisiting use and occupancy ....... b Intended use and occupancy .............. "/....~...,....,...~.....~...~ ......... 3. 'Nature of work (check which applicable) New Budding.. ............. Addition ..... ~ ....... Alteration ..~.. ......... Repair ............... Removal ................. Demolmor. .............. Other Work .......................................... (Description) 4 Estimated Cost ...................................................... Fee ...................................................................... (to be pa~d on filing this opphcat~on) / 5 If dwelhng, number of dwelhng umts .............. /. ............. Number of dwelhng units on each floor .......................... tf garage, number of oars ...................................................................................................................................... 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7 D~mensions of existing structures, ~f any' Front ....................... Rear ................................Depth .................... HeLctht ........................Number of Stones .......................................................................................................... Dmqensions of same structure with alterations or addmons' Front .................................... Rear ..................... DeF. th ................................ Height ...........................Number of Stories ................................ 8 D,mensions of entire new construct[on Front ....... . .~.......~. ................... Rear ...... ..c~.....~.. ............ Depth. ~ ......... Height .................. Number of Stories ................. ~ ........................................................................ 9 S~ze of lot' Front ................................................ Rear ................................... Depth ........................... 10 Date of Purchase .................................................. Name of Former Owner ....................................................... ............D./...-s.T 1 1 Zone or use d~stnct m which premmes are s~tuated . ~ .... 12 Does proposed construction violate any zoning law, ordinance or regulation ......... ~..0. .................................... 13 Wdl lot be regraded ..... ~/.~.~.~ ........ Will excess fill be removed from premises: ( ) Yes ~-~N° 14. Name of Owner of premises .................................................. Address ................................Phone No ...................... Name of Architect ................................... Address ................................Phone No ..................... Name of Contractor ........................................... Address ................................Phone No ..................... PLOT DIAGRAM Locate clearly and d~st~nctly all buildings, whether ex~st~ng or proposed, and indicate all set-back d~mens~ons fror propcrty hnes Gwe street and block number or description according to deed, and show street names and indicat whether interior or corner lot STATE OF NEW YORK, [ S S COUNTY OF ...,~/r~..//4.~ ....... f '~ . .......... (~,~;./~6~i..~i~7,¢c.~{7¢~.~ ............ be,rig duly sworn, deposes and s~ys that he ,s the apphca above ncmed. He the .......................................... ..... . ......................... . ...................................................... tuonrractor, agent, corporate off~cer, etc.) of sa~d owner or owners, and ~s duty authorized to perform or have performed the said work and to ~ke and f th~s applicahon; that ~1I statements contained m this apphcat~on are true to the best of h~s knowledge and belief; a, that the work will be performed in the manner set fo~h m the apphcation filed therewith. Sworn to before me this ........ ~...,;...~ .... day of .............. INOTO~ ~'UDIIC, . ...................... ~'"'FZ~g"~' ~oun~ ........... [ ....... ~ ........... ~r~.:~ .................................... .~ ........... ~ ~/ t z - ~,~ . ~S~ture of applicant) ] [L~AB~H ANN N~ILL~ NOTARY PUBLIC, State of New York No 52 8]25850, Suffolk CoBnty T~m E~plre~ March 30 19~ 0~ REVISIONS JUN£ ? t 1977 I.IN~UTHO~iZED &LTER~I, TiON OR ADDITION ~ ~or£ , I = MONUM£NT YOUNG i& YOUNG 400 OSTRANDER AVENUE, RIVERHEAD, NEW YORK ALDEN W. YOUNG HOWARD W. YOUN{ PROFESSIONAL ENGINEER AND LAND gURVEYOR SURVEY FOR: JOHN J. MAt~TIN Br AMELIA M../~A~ · o~. o~~~ I ~ ~~ /~// OLK CO., N.Y. SUFF SCAL~: