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Home My WebLink About3278-zFORM NO. 4- TOVv'N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EIERTIFIEIATE [DF OEIEILIPANEIY No. Z 2886... Date. O~gobe~ 20 . , 167.. THIS CERTIFIES that the building located at ~tt~ohson' · l~oad .... Street Map No. ~ Block No. ~ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~to)~ ).~/ , 19 66 pursuant to which Building Permit No. dated ~f.O):~ ~? , 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 issued is oae £~tlF. ~elltr~,. ~bJe~t .to ~he ~:emoval..Q~. ~l~-u~ .Q£. · The cer~a?~P~ ~ou.ee:...~,~,,1, .X.. ~,,,~,,,,~...-. ~,e~. ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... ~/~ ............... TOWN OF SOIJTHOI. D BUILDING DEPARTb~ENT · TOWN CLI[RK'$ OFFICE SOU?HOLD, N. Y. · BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 3278 Z Permission is hereby gronted to: ..... ..~.~..~tt~....~'.C..~m,~..~ at premises located at ~,J~.....~.'~'~l~]~llO~.~[ ............................................... ~ ................................. ........................................... ~.~..~...~.,.~.,. ................................................................................. . pursua~¢ to application dated ..................... t~l~ ........... ~ ............... , 19~..., and approved by tl~e Building Ihspector. ~lO~l~ ~ ~e~ ~I~ ~e~ ~ ~ ~~ ~ O~ e~st~g d~l~8 ~ter ~ ~e ~s ~pt~ on ~e lot ........... FORM N~. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~.~..~.....o../.~ ............. , 19~...f.:. Approved '' , 19.' ....... Permit No.--~ D,sopproved a/c ........... ;.5~..~.~ ........................ (Building InspectS)' Application No ............................ APPLICATION FOR BUILDING PERMIT ......................... ........ ..... INSTRUCTIONS a This applicohon must be completely filled m by typewriter or in 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 giving a detailed description of layout of propertymust be drawn on the diagram which is part of this application c. The work covered by this apphcation 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. Sucl permit shall be kept on the premises avadable for inspection 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 Certificate of Occupanc~ 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 thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulahons, for the construchon of buddings, add,hans or olterohons, or for removal or demolition, as herein described. The apphcant agrees to comply with oil applicable lows, ord~r~nces, building code and regulations/. . _ (S~gnature of applicant, or name~if a corporgtion) ~ ............... ................ : ........................................... (Address of a~ ........ '7' ..... State wh/e~ther opplic~g~t ~r, le~ent, architect, engineer, general contractor, electrician, plumber or builder. : ac~; 1 ::o°n~V :: ra° fc oP:;~:I ~~i~f:~ ;:~i:~~ ......................................................... (Nome and title of corporate officer) 1 Location of land on which p,~p/ose_d wo~ will be done. M~ap No: ...... , .......... .~ ................ .~.. lot Ix[o: .................... Street and Number .... ~ .... ~ .............. Municipality 2. State ex,st,ng use and occupancy o~_emise, s a/g)J~mntended use and occupancy of proposed construction: a. Existing use and occupancy ...~..~f.~~~ ................................................................................... b Intended use and occupancy .... ~.J~... ........................................................................... / 3. Nat~jre of work (check which apphcable). New Building .... /~............ Addition ................. Alteration ................ Rep6ir .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4 Est,mated Cost ........... ~..-~..,..~..~...~.....~.. ......................... Fee ...~.....~....~ .................................................................. (to be pa~d on filing th~s application) 5. If dwelling, number of dwelling units ........ ./.. ................. Number of dwelling umts 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 existing structures, if any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories .............................................................................................................. D~mens~ons of same structure w~th alterations or additions. Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8 Dimensions of ent, re new construct,on: Front ..... ..~...~...-- ............. Rear ....~...~.. ............... Depth ....~....(~ ............. Hmght .... J.~_~ ................. Number of Stories ...... .J. .................... 9. S,ze of lot: Front ../..J..~..~. .............. Rear ..~..ff..~...'~. ............. Depth ../...?..~.... .............. 10 Date of Purchase ........ ,~..~...~-..'~...,~r.. ........................... Name ~of Former Owner ....... T:~ ............................................ 11 Zone or use district m which premises are situated ....... ~ ................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation~ ..~. ........................................... 13. Name of Owner of prem,ses4~.:~.,~...~.~...~...~..~.../~..~...Address~"~.~.~--~..'~.'.~.~.~..~(,J~- Phone N~ ...... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor~..~./~...,...~....../~....~J../..~.~.. ........... Address~.~..~.~ .~../.fi.i~....~ ........Phone No. ?....~....~'....~.... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions flor property hnes. Give street and block numbers or descnption according to deed, and show street names and red,cat whether interior or corner lot. "'0' ii~ OO STATE OF N .EWI~.ORK~ . ~ j,, / ~, COUNTY O~ .~ S S. '"'~'~~v,d ~" s~ ~n) be,ng duly sworn, deposes and says that he is the applicar 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 said work and to make and fil th~s apphcation, that all statements contained in this application are true to the best of his knowledge and belie[ and that the work will be performed in the manner set forth in tk)e application filed therewith. Sworn to before me th~s ,-z ~ / ' // t // ......... · "': ..... ..... i> ......... ............. Notary Public,4./...).~~.X:.~~ ........ Cgunty (Signature of applicant) / NOTARY PUBLIC, S[ate??,,~? _Y,o~ flo 52-3233120 Suffoik County~ ~ ' Term Expires March 30,