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Home My WebLink About3298-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. ERTIFICATE OF OP.P. UPANP. Y No. ~ 2699 .... Date ...... Octo~el:. ~0 .......... , 196~.. THIS CEI~TIFIES that the building located at B~'t~ .Avenue ................ Street Map No.. )(~( ..... Block No ..... ]00( ....Lot No... ]O0[ ........ P.-,&I~., ~:~]~,llo.~. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..... No. ve~]~. 1 .... , 19 6.6. pursuant to which Building Permit No. 328t~. ~.. dated ...... l~ovembe]~. 1 ...... ,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 ....... a..~. ~..tll~..` ~:.o....o~...~..~..J..l.~r..~..e.l.1..~. 9. ............................. The certificate is issued to ...... W,t].l~,am .~T.. C~'o~l~It...-. I~mez ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ II/~ ....................... FORM 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) 3298 Z Permission is hereby granted to: ............. W.l.]:-l.~am..J.,.. C~w.le~ ....................... .................... ~r..A~ ........................................... ................. ~.~ez£c~ ................................... to at premises located at .......~.~....~...&~.e ........................................................................................ ................................................ · a~l-t,~a~.~ ~,..... ~, ~., ....................................................................... pursuan,t to application dated ............................. ]t~O~l'~lab~' ....... 'i.., 19..f~6, and approved by the Building Inspector. Fee $. ,~.. a OD ............. FOI~M N~O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved ..................... !.! ................ , 19..~...~erm,t No. ~ ~)~ ~ ~¢~ ~ D~sapproved a/c ..~....~ APPLICATION FOR BUILDING PERMIT ..................... ................. INSTRUCTIONS a Th~s application must be'completely filled in by typewriter or ~n ink and submitted in duplicate to the Buildin- Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adloinlng premises or public streets o areas, and giving a detaded descnption of layout of propertymust be drawn on the diagram which is part of th~s application c The work covered by this apphcat~on may not be commenced before issuance of Budding Permit. d Upon approval of this application, the Budding Inspector wdl ~ssue a Building Permit to the applicant. Sud 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 In part for any purpose whatever unbl a Certificate of Occupancy. shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Budding Permit pursuant to th.- Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulabons, for the construction of buildings, additions or alterabons, or for removal or demolition, as herein descnbed The apphcant agrees to comply w~th all applicable laws, ordinances, building code and regulations. --¢/~ fi~ .... (Signature ~,4~pplicant, or name, i,¢f/a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder .(~..~.~.~ R Name of owner of premises ......... .~../.~./.~.~....~. ..... ...~...' ...... ~.¢.~. ....................................................................... If applicant is a corporate, signature of duly authorized officer (Name and title of corporate officer) "; 1. Locabon of land on which proposed work will be done. Map No: ........... '~ .........~. ............. Lot No' Street and Number ......~......~'...~... ..... ~.~ ........ ~~ ....... .~ .......... ~....~.('.~ .......... ~/ Municipality 2. State exishng 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 ~.....y..~ ..... Repair .................... Removal .................... Demohtion .................... Other Work (Describe) .............................. z ..... [st~mated Cost ........................................................... tee ........................................................................................ (to be paid on fihng th~s apphcation) If dwelhng, number of dwelhng umts .......... ~i ..... Number of dwelling units 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,mensions of ex,sting structures, ,f any: Front .....~.~..£..~...X. ....... Rear .:~.~....4¢'.~..~, .~. .... Depth ..:.~...~....?..~:.~:.Z'.. .... Height ...... I..~...~..~.~ ....... Number of Stories ............. ./. .............................................................................................. D,mens~ons of same structure with alterations or addmons: Front ........ ..~'...~. .................. Rear ...:.~.~ .................... Depth ....~.~' Fr' Hmght /,~- ~c,¢~,- ,, , ! . ........................................................ ~NumJ)er of Stories ....................................... 8. D~mens~ons of entire new construction: Front ........ ./.~.....~Z'. ...... Rear ....(..~.....~.'/T. ......... Depth ...~.....?..?..: ......... Height .,./.R.......~'.: ............ Number of Stories .......... ./. ................ 9. S~ze of lot. Front ............................ Rear ............................ Depth ................................ 10 Date of Purchase ..~[~..~..~.,.Z.~..,~..~. .......................... Name of Former Owner ....~...~..~..¢.)4...../~..~...~.~.$. .................. 11 Zone or use district in which premises are s~tuated ...... ~..~f:~/~/l~...~-,~ .~../~..~'..~..~... ................................................. 12. Does proposed construction violate any zomng law, ordinance or regulation? ........ ./~'...~ ..................................... 13. Name of Owner of premises ~./.¢//~.e/,~..~......~.~.~Y.. ..... Address .~.~,,,K....,f)...~:C,....~.FJ4Z..J.I~.~I~./,.~ Phone No.~..~...Z.'../..~ Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor ~'/.~'.~:~/;. ..... .~..~Z/..'Y, .................. Address ~'~ ~n~P/'~~ ,.P.~, ,_Phone No ............................ &~ ~,./,.~ ~ .................. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro~ property hnes. Gwe street and block numbers or description according to deed, and show street names and ind~cai whether ~nterior corner lot .......................... ~...~.....(~ ...... ~.....~... ......... be g duly sworn, deposes and says that he ,s the applio (Name of individual signin~tion}.. above named. He is the .................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and th,s apphcati~;, that all statements contained ~n this application are true to the best of his knowledge and bel and that the work w~ll be performed in the manner set forth m the apphcation filed therewith. Sworn to before me this .................... ~ .... Nota~ Pub hc,~.~ ~ [.. .....