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Home My WebLink About3253-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. ERTIFIP. ATE OF DOP. UPANP. Y THIS CERTIFIES that the building located at ~d~w ~agh ~.ane Street -ozz Van~on ltd.' ..... Map No. Block No ...... Lot No. Cut:ch99~. e.,..L.: conforms substantially to the Application for Building Permit heretofore filed in this office dated .. .Oc~.,. 4 ..... 19 66 pursuant to which Building Permit No. Z 325~.. dated Oct;. 4 .... , 19 6.6, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ....t~..iv,.t.e...o~?..~.?i. 1..y...d~..e.l.1..~.~...~.i..th. ~.C.?e. ?.a.o.~..y..b.u.i..1.~L.t..n.9. ....... The certificate is issued to ...... ~.Oy..L.:..B.~.t..C~..ey. ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .................... FOR~ NO. 2 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? 3253 Z Permission is hereby granted to: .......... Ro~..... L....,Br,t. cke~ ................................. ....... Cutcho~u~ .................................................. to i~,eo t,..e_~d.. ~a..~n. ta.~.n., an...aeeet sez,y...building...(,...too 1 .. Shad) .......................... at premises located at .-~4ead. o~-...liteac,-h...I,a~..ott£...Vaits, ton..l;~oad ........................................ ......... lmt~a..322...&. 32~.... ~qas sau,....P~ntt.....C~tchc~s~e .................................................... pursuant to application dated ..................... OCt, ......... J~ ................... , 19..(a~, and approved by the Building Inspector. Fee $......~*.1~0 ......... Building Inspector F~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~"~' J~ 19~:~ Approved ........................................ , 19 ........ Permit No ................................ Dtsapp roved a/c ................ Application No ............................ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................... ~......¥L .............. ,19..~.....~.... INSTRUCTIONS o. This opphcation must be completely filled in by typewriter or in ink and submitted in duplicate to the Buddin, Inspector. b Plot plan showing location of lot and of buildings on premises, relationsh,p to adjoining premises or public streets o areas, and g~vlng a detaded description of layout of propertymust be drawn on the d~agrom which is part of this application c. The work covered by this opphcot~on may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bud&ng Inspector wdl issue a Building Permit to the applicant. SucJ permit shall be kept on the premises available for inspection throughout the progress of the work. e. No budding shall be occupied or used m whole or m part for any purpose whatever until a Certificate of Occupano. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Budding Permit pursuant to th. Bu,ldmg Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alteratlor~s, or for removal or demolition, as herein described The opphcant agrees to comply w~th all apphcable laws, ordinances, budding code and regulations. ........ . ................................ (Sig of appl~?/o~r harry, if a corporation) ....................... ...................... State whether apphcanf is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budder Name of owner of premises .................................................................................................................................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate off,cer) ~' ~o'~~~ 1. Location of land on which proposed work will be done .... .~. ............. Lot No: .,~...~...~.. .... Street and Number ..................................................................................................................................................... Mumcipality 2. State existing use and occupancy of~ ~ ~premises tand intended use and occupancy of proposed construction: a. Ex~sting use and ~cupancy ..... ~~.~...,: .............................................................................. ..... .................................................................... 3 Nature of work (check which applicable): New Budding .... .~. ..... Addmon .................. Alteration ................. Repair .................... Removal .................... Demolmon .................... Other Work (Describe) ..................................... 4. Eshmated Cost ..... J~.~.'.:, ......................................... Fee ......................................................................................... (to be pa~d on fihng this application) 5. If dwelhng, number of dwelling umts ............................ 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~sting structures, if any: Front .......................... Rear .......................... Depth ........................... Height ........................... Number of Stones .............................................................................................................. D~mens~ons of same structure with alterations or addmons' Front ................................ Rear ............................... Depth ............................. Height ............................. Number of Stories ........................................ ...... g...'. ............... 8 Dimensions of entire new construction: Front Rear ............................ Depth ......................... Height .~..~...~'.~. ................. Number of Stories ............................ 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 ............................................................................................... vig, late any zoning law, ordnance or regulahon 12. Does proposed construction ..../~..~...~..~.prem,ses ..... .... ' ........................ ~7~', ~ ....... 13. Name of Owner of ~J / Address ~~.~....~. Phone No.~J....~..~..~.. Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor .................................................... Address ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and d~st,nctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions fror property hnes. Give street and block numbers or description according to deed, and show street names and mdicai whether interior or corner lot. STATE OF NE~.YOP-)K~.,, I J,~ ~ c c COUNW OF L. ~ --~.....~.f~.~....'. ............ '-'.".being duly sworn, deposes and says that he is the applica .............. (Name ~f individual signing applicd 'on) above named. He is the ............ ~....~ .............................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the smd work and to make and f th~s apphcm~on, that all statements contained in this application are true to the best of his knowledge and belk and that the work w~ll be performed in the manner set forth in the apphcation filed therewi~. Sworn to before me th~s ~ ~ ~ day of ~ , 1~~ ~ ~ ~~~ Notary Public ~~...~.:...~.~..~ ~ounty~-~'~na~'~re o~~ ................ NOTARY PUuu~, ~ ~ '- ~o 52 3233120 Su[~ol'x ~