The URL can be used to link to this page

Home My WebLink About3229-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOV~N CLEI1K'S OFFICE SOUTHOLD. N. Y. BI:'RTIFIr:.ATE: InF Inr:.P. UPANI'-:.y No. Z 2648 January 31 ., 19 67 · ~. f ....... Date .................................. ,Ti~IS CERTIFIES that the building located at .Y..O~.~.g.s...A.v..e:..%...M~..~.h.a..n.Y.c... Street Map Np. )GiX Block No. XXX Lot No. XXX Southold eonfg~s substantially to the Appli~ati,on for Building Permit heretof, ore filed in this office /' dated .... S?.p..t?..r~. e.l~...~.0. .... , ~9.6..6. pursuant to which Building Permit No.~.Z... dated..,/ ..................... 8epi:eral~r 20 , 19.~6., was issued, and conforms to all of the require- ments .of the applicable provisions Of the law. The occupancy for which this certificate is (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Appr, oval ............................ Building Inspe~t~r ~ ]FORM NO. 2 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) No. 3229 Z Dote ~11~1~ ;~ 19 i~ Permission is he,by granted to; ...~.~...~.,U,.~...&.~.....~.~m:...~...~ .......... pursuan¢ to application doted .............................. ..~..~.~..~. ....... ...~... ....... , 19.....6~..., and ?pproved by the Building Inspector. ~ Building Inspector FO]~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. Disapproved ~ .................................... ........................................... ............... '~"' (Building Inspector) Appl,cation No. 3 ~ ~ ? APPLICATION FOR BUILDING PERMIT Dote .......... ...-~...~..~....~.. ....... . .,~....O. ................. , 19..~...~.. INSTRUCTIONS o. Th~s application must be completely filled ~n by typewriter or mmk and submitted in duplicate to the Buildm. Inspector. b Plot plan showing location of lot and of buddings on premmes, relationship to adjoining premises or public streets c areas, and gwmg a detailed description of layout of propertymust be drawn on the d,agram which is part of this applicatior c. The work covered by th~s 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. Suc permit shall be kept on the premises available for inspection throughout the progress of the work. e. No bu~ld,ng shall be occupied or used in whole or in part For any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuonce of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances ~_ Regulat,ons, for the construction of buildings, additions or alterations, or for removal or demolition, os herein describe, The opphcant agrees to comply with oil apphcable laws, ord,nances, budding c. ode and regulations. ........................ .............................................. (Signature of applicant, or name, If a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde ................................. ...................................................................................................................................... Name of owner of prem,ses ............ .i~..~.....'('.~...~....A/....~. ............ C~..~./....C..~. ................................................................... If applicant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No' . ...........................................Lot No' . ................. Street and Number ............ ~.'0..~../~..~'.i~ .............. .~...6..~...AC....(z.,~ ..... ~..~..~.. ...... ..~....~..~_~.~..~...,/~..(..c... ..... .~...~. ........ ~ Mun~opality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ............................................................................................................................ b Intended use and occupancy. ?~.Z.. ....... -- ¢...~....~...,,4~..~..~... ................................................................................ .! 3. Nature of work (check which applicable). New Building ....... /~. ....... Add~hon ................. Alteration ................. Repair ................... Removal .................... Demolmon .................... Other Work (Describe) ..................................... 4 Est,mated Cost ................ ,~/..~.. ~...0. .............................. Fee ......................................................................................... (to be pa~d on filing this apphcation) 5. If dwelhng, number of dwelling 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. D~mens~ons of ex~shng structures, if any: Front ..........................Rear .......................... Depth ........................... Height ............................ Number of Stones .............................................................................................................. D~mens~ons of same structure w~th alterahons or addmons: Front ................................ Rear ............................... Depth ............................. Height .............................. Number of Stories ........................................ 8 D,mens,ons of ent,re new construction' Front ........ .c~.....~. ........... Rear ............................ Depth .......~.....~. ............. Height ........... .f~'..~ .......... Number of Stones ............................ 9. S~ze of lot Front ............................ Rear ........................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use d~stnct m which premises are situated ............................................................................................... 12 Does proposed construction wolate any zomng law, ordinance or regular,on;~ ......... .~'.....~. ................................... 13 Name of Owner of premises ./~.,.~'.f~..~...C.L.~...z'/ ............. Address ....... ~....O..(..?...~.~.~.~. ............... Phone No. Name of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor ...~..~'...~....~.0..~..?...~..y~.~..~..~..~ ......... Address ......~4~/~..]~...0~.~'.~. ............ Phone No. ~...~..~.Z...~..6.. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fron property hnes. Give street and block numbers or descnphon according to deed, and show street names and ,nd~cat. whether interior or corner lot. ~ J f~ ~ STATE OF NEW YORK, ~ ¢ c COUNTY OF ................... ~.~ ........ f ~'~ ~... be ng duly sworn, deposes and says that he's the app 'car ........................... ~.~:....~ ........................ . ..................... (Name of ind~wdual signing apphcahon) above named. He ~s the ............... .~.~ ..... ~.~/~..(~.~..#..K'~ ............................................................................................... (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 fi th~s apphcotion, that oil statements contained ~n this opplicahon are true to the best of his knowledge and belie and that the work will be performed in the manner set forth m the apphcation filed therewith. Sworn to before me this ............... .~D .... *-~ _ ~ ~ x-~ ~ ~ ...._......_~..day of ... _~~~~..., 19..~..~ ~ ...~..~ ~~ount~.' ........... i~'~;~u re ~"~l~ii~:'~)' .......................... Notary Pubhc,