The URL can be used to link to this page

Home My WebLink About6079-ZFORM NO, · TOWN OF SOUTHOLD BU~.BING DEPARTMI~.NT Town Clerk's Office $outhold, N. Y. Certific; te Of Occupnncy No. Z(:II~ ~. ..... Date ............... .l~y .... THIS CERTIFIES that the building located at P.~.T. Roa~-,. P~so~.Or. BO~4 S~eet Map No..Ft..~r~t Block No..(~YJ .... Lot No ..... F~shsrs. [sl~ .. N...Y, ..... co~or~ subst~tially to the Application for B~ding Pe~it heretofore filed ~ ~ office dat~ .............. A~.. 2, 19..72 p~su~t to which B~d~g Pe~it No...~07~ dated ............. A~ - -¥. -, 19.. ~ was ~sued, ~d confoms to ~ of ~e ~q~ ments of the applicable pro,ions of ~e law. The occup~cy for wMch ~is ce~fficate issued ~ .Pr~te. ~. ~d .~11~ .... ~ .aO~sso~ .b~ld~ ...... ~e ce~ificate is issued to . .N~y. H~e~. .... ~e~ ............................. (o~er, lessee or ~n~t) of ~e ~ores~d b~ld~g. S~olk County Dep~ment of He~ Approv~ ... PgB~$P~ ........................ ~DER~ITERS CERTIFICATE No..~$~. ~..~. ~. ~ ~.~ ........... HOUSE NUMBER ..... ~ .... S~eet .......................................... ..... FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 6079 Z Dote .................... ~dJ~l~JJ....J6 .........., 19..~. Permission is hereby granted to: ~aJ ~Jt~ae t4ae ..I~.. llaJeg, · .~elml, ............ .............. ieiohos*~...toZ~d ................................ at premises located at ...... O~/l"JJ~lrt,4Ji4J ...... ~(JFiJ~"ll3qlJ) ........................................... ............................................... l~elm~..$el~J~ ......... I.~Z.~ ...... ...................................................... pursuant to application dated .......................... &~.....~ ............... , 19~..., and approved by the Building Inspector. Fee $~'0~0' ........... 8UiLDJN~ DEPArrMB4T TOWN CLIRK'S OPiqCl SOUTHOLD, N. Y, Appraved ............c~.. ....................... , 19 ........ Permit No ............................. Disapprx:wed a/c .............................................................................................. ^l:~lic.~tion No ............................. APPLICATIOH FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duPlicate to the Building I nspec~Gr. b.. Plot plan s~wing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and gi~ieg a d~led description of layaut of property must be drawn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. epp~wal beUpq~fl~ ~et l~lJ of lftJs application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall premlm available for inspection throughout the progress of the work. e. Nc~uJ~ll be occupi..e~, or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Budding Inspector. APPLICATION IS HERESY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building ZalM:iOrdtmOnca of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or ~eU~lations, f~ tfflt i~struction of buildings, additions or alterations, or for removal or demolition, as herein described. =pplicer~ o~rees to comply with all applicable lows, housing code, and ordinances, btJ~Jding code, ~a roaulatlofls. - (/[pure~~or (Address of applicant) Statewh~s~t, architect, engineer, general contractor, electrician, plumber or builder. ' '~"~/v~'~ "~(~an~"t~o f' ~rpo rate .... offic..~,----.- ~;~ ................... land on which pj~m:~:l, work will be doge. Map No.~.~..~..~.~..(~...:...,~... Lot N~.~ !,..~.. ............... / / ~ Mun:cipality ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed t:onstruction: b. Intended use and occupancy ... ~ ~ ~ ~ 3. Nature of ~.(eheck which applicable):. New ~Building ,.~ ......... Addition .................. Alteration .................. Repair .................. ,v~Rem°val .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cast.............~:. ~.d~,~.. ...............;.., ...... ;Fee .......................................................................................... ~ '(to be paid on filing this application) 5. If dwelling, number of dwelling units ........ t..=.,.. ......... Numl~er 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 of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ of ? ' Depth ................ ..~ ....... .4=leight ............................ Number Stories ................. : ..... 8. Dimensions of entire new construction: Height .................... Number of Stories ................................................... .~..? ...................... ~.~. ............... 9. Size of lot: Front .-.,~f~J-~l~. Rear ....e~.J..~'~ .......... Depth ~.~.....~;... 10. Date of Purchase .[~l~l~..~.:l....J.~..~ ...... : ....... Name of Former Owner 11. Zone or use districteln which premises are situated ................................................................................. 12. Does proposed construction violat~ any zonin~g~l~, rdinanc, or regulation.;) 13. Name of Owner of ... Phene No~. · ~S~..Address Name of Architect~j?_/ _ _j~~. .......... ,Address ..... Phone No.~t~..~1~ Name of Contractor ~.~.~.. ~ ~;.~~'~ Phone No. · , .......... Address 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, and show street names and indicate whether i'nterJor or comer lot. STATE OF NEW....YO~I~, ^ ~,, 1. ce ' COUNTY OE~~ ..... $ '~'~' a. ................. · (.-.~i~:~.'. ........................ being duly sworn, deposes and says that he s the app cant N ' '~ual sl~ning application) ' above named. He is the ...~w~w~ .................................... .... i .............. ~ ..................................... (Contractor, ~ 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 contained in this application are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set forth in the application filed therewith. Swam to before me this ~ ........... Coun ............. .......................... . LUCtiY~.gJ, HMA-~_ - . f ~]rures,or appll~ ~, ~o..-.~028880 .~ 'N LO-I-~ E~ IDLN£,I~, FOR MR. O MI~ I~DER. i(;K H1CKEY {SIIERS ISLAND Nk~W 'YORK