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Home My WebLink About3258-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTIV[ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. r. ERTIFIP. ATE DF DP.P. UPANr. Y No. Z 2882 ... Date .O~.t.ob. er.2.0. ,19. THIS CERTIFIES that the building located at Bay AvSnue .... Street Map No. XXX Block No. ~ Lot No. ~ 1~. t.t.i.t.u.c.k.:.N...Y.: conforms substantially to the Application for Building Permit heretofore filed in this office dated Octobe= 7.0, 19~6 pursuant to which Building Permit No. 3258 dated ~-,OCtO_I~F 10 19 66 was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is msued is l~.Bslne~..~..~.t..oF.~.g~...~.u.i.t..d.i.n~. ........................... The certificate is issued to ......... .~.Oh~. j~lii~.e...-..0~..r~.r ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... .N.~. ............. Building I~pector FORM 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? 3258 Z D~te ........................... O.O. tD.J:leZ.....~g..., 19....-~ Permission is hereby granted to: ................. ,1'~ ..]~tae .....J~. ............................. ..................... ~iat ~,i~ .................................... to ..3u.tlct..aew..ac~e~s~'Ir...ato~aga..l~d~ .......................................................................... at premises [ocoted ct .Fa/~q....,1~a~...A~r~, ............................................................................................. .......................................... .~.t t,~..t..a..~.l~.,... I~. ,.~.~ .................................................................................. pursuan¢ to applicotion dated ............................... O¢.t ....... ~ .......... , 19..~6., and approved by the Building Inspector. Fee $ .~,.0:0 .............. Building Inspector lq}II3i NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, FI. Y. ........ Approved ........................................ , 19 ........ Permit No ............... ............. ................................ APPLICATION FOR BUILDING PERMIT Date ...................... ........... , .... INSTRUCTIONS o. Th~s ~pplicahon must be completely filled in by typewriter or m ink and submitted in duplicate to the Buildin~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and gw~ng a detailed desc,ption of layout of propertymust be drawn on the d~agram which is part of th~s application c The work covered by this application may not be commenced before issuance of Budding Permit. d. Upon approval of th~s apphcation, the Building Inspector will issue a Building Permit to the applicant. Suc} permit shall be kept on the premises available for ~nspection throughout the progress of the work. e No building shall be occupied or used in whole or m part For any purpose whatever until a Cemficate of Occupancy. shall have been granted by the Building Inspector ,APPLiCATiON IS HEREBY MADE to the Budding Department far the issuance of a Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulahons, for the construction of buildings, add,hans or alterahons, or for removal or demolition, as herein described The apphcant agrees to comply with oil apphcable laws, ordinances, budding code and regulations. (Signature of applicant, or name, if a corporahon) .................... ...................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber ar builder Name of owner of premises .... ,l-O)~ll..~.~k.iI. ~i~- ....................................................................................................................... If applicant is a corporate, signature of duly authorized officer (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ............... ~ ........................ Lot No: .~ .......... Street and Number .... ~....~..~ ............ ~i~k .................................................................................. Mumcipality 2. State ex~stmg use and occupancy of premises and ,ntended use and occupancy of proposed construction: a. Existing use and ~cupancy ...... b~~...~o~e~%~....~a.%...sa%~....~..~¢o~..~ ................. b. Intended use and occupancy ..... ~ame..~.~h...8.Bo~ge..b~.i.ld.~R~ .......................................................... 3. Nature of work (check which applicable) New Building ...... ~ .... Addmon .................Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Eshmoted Cost ....... '~'~'~)0'*~]~ ............................... Fee ...... ~. ............................................................................... (to be pa~d on fihng th~s application) 5. If dwelhng, number of dwelhng units ..... ~;):[~ ............. Number of dwelling umts on each floor .......................... If garage, number of cars ........................................................................................................................................ 6 If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D~mens~ons of ex~st,ng structures, if any' Front .......................... Rear .......................... Depth .......................... He,ght ........................... Number of Stories ............................................................................................................. D~mens~ons of some structure w~th aiterahons or additions' Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. D~mensions of enhre new construction. Front '*'.~6 .................... Rear .....~ .................. Depth ....~]6 ................. Height ............................ Number of Stones ..4:~e .................. 9 S~ze of lot Front ............................ Rear ........................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ...................................................... 11. Zone or use distnct ~n which premises are s~tuated .......... ~:~. ............................................................................. 12. Does proposed construction wolate any zomng low, ordinance or regulation? ..... ~ ......................................... 13. Name of Owner of premises ...... ~,]~l,~e. ................ Address ...... ]~.~.t,~]~. ................Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Nome of Contractor ............. ,~,~ ............................. Address ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and c~istinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro, property hnes. Give street and block numbers or descriphon according to deed, and show.street names and ~nd~ca~ whether interior or corner lot. STATE OF NEW YORK, ~. S.S COUNTY OF ...[~1~'~4).3~ ....... ......................................... ~ZZ..]~..~ ........................ being duly sworn, deposes and says that he is the applic, (Name of individual s~gning applicahon) above named. He ~s the ...................... I:)'~ze~'..,~..~.v,$3~de.l~ .......................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners and is duly authorized to perform or have performed the sa~d work and to make and th~s apphcahon, that a I statements contained in this apphcation are true to the best of his knowledge and bell and that the work wdl be performed in the manner set forth m the apphcation filed }herewith. Sworn to before me th~s ..................... ZQ day of .............. ~.~ ............. , 19..~6. Notary Pubhc, ~j ~.,.~, ............. ~.....~. County '~'~"~nat~ applicant) Term Exn~re~ March~[~