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Home My WebLink About3244-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. GERTIFII~.ATE I-IF FIE:P. UPANI~,Y No. ~. j49.02 ..... Date ...... O¢~c~e~..:~0 .......... , 196~.. THIS CERTIFIES that the building located at . tto~t~ .~$ ................. Street Map No ..... ~. Block No...~ ...... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... ~,~g~r. 2?., 19 .(~6. pursuant to which Building Permit No. dated ...... ~;~,~ .30 .... ,191~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ... t;~. t~ialat~, d~,ll,iil~. ,- .l~t~,~ior~ .i1,£. ~o~d ~t~. itl}i~l~l,8 ...... The certificate is issued to ......... F~:a~. ¢ou~ .... ~r~l; ....................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ............ 1~./8. .................... 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) 3244 Z Permission is hereby granted to: lh~.ii~J~..i..~m~..A/~ ....l~..~... ...... ~$~1~,,..~.~.~ ..................................... at premises located at .JJ~....JJ&,~I3..,~.A' .~.~..J~...JJl~4J. .................................................... ............................................... ~t..l~j~..x.l~.o ........................................................................ pursua~tc to application dated ....................... ~J~t~lJ~J~ ....... ~jJ..., 19..~., and approved by the Building Inspector. ~j~j~ ~, ~l'~l~pO&l_I Fee $..~.~ ............ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. xomined ...~ .................. , 19/-~ ~ Approved ........................................ , 19 ..... Permit No ......................... Disapproved o/c .............. ~ ................................................................... j /'. (Building Inspector) Application No.....?......~/....~...,r~. ..... APPLICATION FOR BUILDING PERMIT Date .~.~....~.....~.....TT .......................... , , .~...~.. ..... 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 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. Upon approval of this application, the Building Inspector wJJl 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 Jn 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 o 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, ordinances,/building code and regulations. 'Fo .... ....... (Signature of applicant, or name, if o corporation) ................. ....................... d~ ~ ~.,~T~[./~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ......... - :- ............... i ............................................................................... Name of owner o~f l~remis6s-'.~..~: .... ~ ~ ................................................................................... ...... (Name and ~tle of co~l~orate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ Street and Number/~.:'~.~..~..~...~..~..~...__ ...~....~... ........................ '.'...~...~....~../.~..~..~.~....~..~.-' -- -- ........................... Municipality 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 ........ .~.....~.~......~. ~....~..~......~....~..~......~....../~.~.: .~.*.. ..................................... 3. Nature of work (check which applicable): New Building '. ................. Addition .................. Alteration ..~ ........ Repair ....... ~... Removal .................. Demolitior(..: .............. Other Work (Describe) .; ....................... 4., Estimated Cost ~ .. Fee ................................................................................. ~../? .... (to be paid on filing this application) U.,ts If dwelling, number of dwelling units ............ .2 .......... Number of dwelling on each floor ...... ~.....:L ....... If garage, number of cars ................................................................................. ?,: ....... , ..................................... , .......... 6. If business, commercial or m,xed 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 ...... ..~..~..~..6~. ............Rear ...~.~.~.~e. ......... Depth ..... .~.. ~.~..~.!~ ...... Height ~' ' " .....~:.~__~__..~ ....... Number of, Stories ........ ~ ................ 8. Dimensions of entire new construction:' Front'. ............................ ~ ...... Rear ............................ Depth ........................ Height ................... Number of Stories ................................................................................................................... 9. Size of lot: Front ...... ~'...~.~;~.?... Rear .....~....~..;...4~ ............. Depth ....~,~../_~..~..~.; .... ]0. Dc~te of Purchase ........................................................ Name of Former Owner ........................................................ ] ]. Zone or use district in which premises are situated ..................................................................................................... ]2."' Does proposed construction violate any Zoning law, ordinance or regulation? ..~.43 ................................................. ]3. Name of Owner of premises ~.~/~',~.~.~.eCr~..'...Address ~.~,4~/.~.J~.~..:.~:.. ........... Phone No ..................... Name of Aichitect ....... > ............................................. Address ...........................~ ............... Phone No ........... ; ......... ' ~,~me of Contrac,o,/~7~..~-.,~.~.~.~.. ,~...~...Address .. .~. ......... Phone No~.~Z.~.~.~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or pr. oposed, .end. indicate all set4)ack dimensions from property lines. Give street and block number or description according to dee. o, and shew street n~mes and indicate whether interior or comer lot. . N "~ STATE OF NEW~ORK, )'SS ' ' COU~NTT OF .~J.U'~'~db/~'"'~- ............... be,n .du, sworn, deposes and se s he',s ,he app,,cant ...... (Name Of, mdividUdl s~gning apphcation) ' ' above named. He is the ~)~C ~) :/ '~. ~ "' ', ag ', re Icer 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 contc~ined in this application are true to the best of his knowledge and belief; and that the wore )Fill be per, farmed.in the manher~ set forth in the application filed therewith. ...... , .................. Notary Pub~~ County (Signature~'~, ~ ~F~li~J~'of applican~l:~' .~.~F~' c'~;~j''"~' No. 52-703~,050 ~,ommission Expires March 30, ~.9