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Home My WebLink About3288-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFrCE SOUTHOLD, N. Y. IgERTIFIP. ATE OF FIE:P. UPANI~Y No. ~ 2895 . Date . ,Octqbe~, 20 . .. , 19.67. TttIS CERTIFIES that the building located at lgia~a~a~, P&~h .. Street Map No. ~X , Block No. ~ .., Lot No. ~ $ot~thold.,l~.1~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated O~tOl~ 27 , 19 6.6 pursuant to which Building Permit No. 3288 4. 3289 Z dated . Oct;obe= 2?. , 1966,, 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 One £amily. d~ellS, ag. and accesso~, bui~.dtng~ ................ The certificate is issued to 2.. Delqa:~ia ..................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval K/it ................... Building Insp~tor · "OR~ 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? 3288 Z Permissiori is hereby granted to: ' ...................... ~lt~.....S:~,m~,~,~.. t,~ ................... ,o .~..~:.,~~..~..~..,,~~..~~ ...................................................... L, at premises located at '.:'--;-.l~l, ~",~F~. ~1 · ',';' ............ ;.--:,---.: ..... ~t~lat.,.~lr~ ...... : ........................................ , ........................................... ~ ..... ,~':'-t ............... -Ot~t ......... .~. ......... , 19...{~, and approved by the .............. ~spe~tor ~ ...... :~, Buildin~ I ......... FO~.~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. Approved ........................................ , 19 ........ Permit No ................................ Disapproved o/c ..j .............. ......................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............ ...~.....~... ....... ...~....Z .................... ,19.~.~..... INSTRUCTIONS a. Th~s apphcat~on must be completely filled ~n 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 giwng a detailed description of layout of propertymust be drawn on the diagram which is part of this application. c. The work covered by this apphcat~on may not be commenced before ,ssuance of Building Permit. d. Upon approval of this application, the Building Inspector w~ll issue a Budding Permit to the applicant. Such 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 in part For any purpose whatever untda Certificate of Occupancy shah have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance 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 buddings, additions or alterations, or for removal or demohtion, as herein described. The applicant agrees to comply with all apphcoble laws, ordlnanc~ing~code ond~reg~ulatlons. 'Z-~(~ (,%> ' L i',=_ '"' (Sig~'~:ur~"~'~'~l~plic~l~,' ;;~i ......... t l., ~ ; , (Address of applicant) State whether applicant is owner, lessee, agent, architect, engigeer, general contractor, electrician, plumber or builder. Nome of owner of premises ~ 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 ................. /...~..;~..~...~........~..~ ................ ~.....~. ............................... Mumcipality 2. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a. Exist,ng use and occupancy .... /......~.~..~--~I~.. · · · .'.~......~...~. · .~. · .................................................................................. b. Intended use and occupancy /,~.~f-~........~.....~.,~/t~....~t-. .......... :.'T....Z~.'t.~:~T.......F~..~.~..~ 3 Nature of work (check which applicable). New Building .................. Addmon /-/ Alteration Repmr ..................... Removal .... I1~ ........... Demohtion .................... Other Work (Describe) ................ ~.....,,,, Est,~ate,~ r'ost :~' ,5~/0 4 .... ,~ ,. ...,. ....................................................... Fee ......................................................................................... (to be prod on filing this application) / 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~sting structures, if any: Front .......................... Rear .......................... Depth ........................... Height ............................ Number of Stories .............................................................................................................. D~mens~ons of same structure with alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of ent,re new construction' Front /~"O' Rear /~' ~' Depth Height ............................ Number of Stories .............. C ........... ~1~'0~ 9. S~ze of lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11 Zone or use district m which premises are situated ................................................................................................ 12. Does proposed construction viola~te any zoning law, ordinance or regulahon? ...................................................... 13 Name of Owner of premises .... ~.:.....~.~..~.~../..~.. ....... Address ............................................ Phone No ..................... Name of Architect ..................................................... Address ............................................ Phone No ..................... Name of Contractor ....~../~...~../.....~..L...0'7./.'~...~...~2~./~'...~.. ........ Address ...~.~....~...~/.?...~..'..~..:.?..~../.~,.~...'(~'..'~Phone No. PLOT DIAGRAM Locate clearly and distinctly all buddings, whether exishng or proposed, and mdmate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether inter,or or corner lot. STATE OF N~~/( ;~ S S COUNTY OF ...'~.../5/....~ .............. / ' t/," 'n /" n ,: / ................... ~:5~....~:~..::...,~ ..................... being duly sworn, deposes ond ~y, thor he i, the opplicont (Name of ,nd,vidual si~~t~o~ above named. He ~s the ......................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ts duly authorized to perform or have performed the said work and to make and file th~s opphcation; that oll statements contained m this applicahon are true to the best of his knowledge and belief; and thor the work will be performed in the manner set forth m the opplicgtion fi[ed therewith. Sworn to befgre'~ (me this .................... day of ........................................ , 19:. ~ RE i ....................... · ........~"'; ....... ;: ............. ,Y ..................... Notaq Public/~~~~{~ (S,gnature of appl,cant)