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Home My WebLink About3301-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EIERTIFIEIATE OF QP. EIUPANEIY THIS CERTIFIES that the building located at 1~/~ ~id~a,~a ][tc~a~ Street Map No. ~1 01)& Block No. . ~ Lot No.. :~t t]k~ltho~l.41 I~,Y, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ][O'f '2 , 19 (~ pursuant to which Building Permit No. dated t[O~ ~ ,19 ~[~, 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 l~i?&~e .O1~ falai],y. ~t'~l].tllg .................................. The certificate ~s issued to ][e~ .]Pi~k~ (Piet~8) .......... ~l' ....... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 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) N9 3301 Z Permission is hereby granted to: .............. ~3....Zloz~b..St .................................... ......... m,,~ t.~.z~t,~cm..,S.t.~tA.m: .... I, X o ............ to .. ,]~1t~1~ .. I~...~.. i"~m~.. ~h¢~] 1 ~ n_~ ................................................................................. at premises located at .~.....~'~..~'~..]~t...(~"~.~.Q~..~.~)....(~``~2~..m~.~ ) ............................................. /~O~t,L .~;I,~ ~ .....I~.,.3L, ............................................................................... pursuan,t to application dated ............................... ~1~1/~.....~,.., 10...~, and approved by the Building Inspector. Fee $ ~1~ *00 ........... · ~ Building Inspec¥OF -"[ ~ ~ ' FO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. TEMPORARY CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the budding located at ..~/.S ..... .~.~.d..-...~..a..~..~...s.....R.~ ....................... Street (L. B. Hill-0 .D .A. ) Mop No ..................... Block No ...................... Lot No X..:~% .......... S..o...~..%..h..o...Z..d..~....~.~..,.~.: ................... conforms substontmlly to the Apphcahon for Budding Permit heretofore filed in th~s office dated ..................... .~.~..O..V.. ........ .2.. ................ , 19~.~... pursuant to wh,ch Budding Permit No. ~.~..0...]:..Z. .... dated No'ff L{. 19.6.~. was ~ssued, and conforms to all of the requirements of the apphcoble prows~ons of the law. The occupancy for which th~s cerhficate is ~ssued is ....... ....... ................................................................................. The certificate is issued to ...H..e.~y....P...i.~.c...h.~.,.ns..ki ........... .O..k.~..,e.~ ................................................... (owner, lessee or tenant) of the aforesaid buHd~ng H.D. Approval- pending S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~/~/ Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located /~~ ~ ~ (Give deed location) have been inspected by this department and found to be satisfactory. FO~ NO. I TO~'N OF SOUTHOLD BUILDING DEPARTMENT E×am ned ........ ........... Approved ........................................ , !9 ........ Permit No ................................. Disapproved a?c ................. ................................. i'~;;i ................................. APPLICATION FOR BUILDING PERMIT ................. ............. INSTRUCTIONS a. This application must be completely filled in 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 o~ areas, and glwng a detailed description of layout of propertymust be drawn on the diagram which is part of th~s application c. The work covered by this opphcation 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. Suck permit shall be kept on the premises available for inspection throughout the progress of the work. e No building shall be occupied or used in whole or in pa rt i~or any purpose whatever unt,I a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the ~ssuance of a Building Permit pursuant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances oF Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described, The apphcant agrees to comply with all apphcable laws, ordinances, b~uild~ng code and .regulations. ($ignatur~/~f apphcont, or nome, if a corporation) ,..~.~ ..... ~.~.c¢,... ~..~c~:r:~ .,~<~..: ~. (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ~,~.4.../..¢.~.....x,~.... ~.~.,...C?.~.~...~ff...~.~ ....... ~e..,....~.,..~.~,~...~.~<~.~,~ ................... .'. .......... Name of owner of premises ............ ~.'~....~...~........~../~..C....~...~J....~..?. ................................................................................. If applicqnt ~s 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 ............. .j~..../.D..z..~...~...~....~..P...: ....... ~.~.4..?....~. ..... Z~.4?...C'.~.....';.....~..O..~...?.~,.o..A....~. ...... ..~..~./, ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... Z~...~.. ...... ~..~/..~'.4Z~/...,~..~ ...... ..~...~.. ...... .~...~(.o.~,~......~..~...,..~...~.....~....~.~..~..?..~.. .... b. Intended use and occupancy ....... ..~..~..~..(.~...~..~...?.X...~...4,. ........ .~...~....~....x~.../...,~....~. ................................................. 3. Nature of work (check which applicable): New Budding b,'"' Addmon Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4 Eshmated Cost .......... ~.~j~..O....o...o. ................................ Fee ........................................................................................ (to be pa~d on fihng th~s application) 5. ~f dwelhng, number of dwelhng 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~mensions of existing structures, ~f any: Front .......................... Rear .......................... Depth Height ............................ Number of Stories ............................................................................................................. D~mens~ons of same structure w~th alterations or addmons Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. D,mens,ons of entire new construction: Front ....7.~ .................. Rear ...,<.~.."..~.,." ......... Depth .....~.f..." ............ ! Height .....,~..~. ............... Number of Stories .... ~ ..................... 9 S~ze of lot. Front ............................ Rear .....~.. .................. Depth ..~ ............................. 10. Date of Purchase ...... ...~...~.?..'......./.!.Z...(..?..~...~. ........... Name of For~m_er Owner ...... .~...f....~..:...~~. 11. Zone or use district in which premises are s~tuated .............. I;/~..~...s....~..D,..~...~...?.../.'~....~.. ..................... ', ........................ 12. Does proposed construction violate any zoning law, ordinance or regulationP ...... ~ ....................................... 13 Name of Owner of premises ........................................ Address ............................................ Phone No ................... ~t~ So~'o Address '~"~ ,¢1/'~.~¢',~'' ~'/'/~'~ Name of Arch,tect .~..~...~ ....................................... ,.~.,...~r,~ ...~Z~.Z ............. Phone Name of Contractor .................................................... Add ess~ ......~ ........ ~..~ ................ ~one PLOT DIAGRAM Locate clearly and &stinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro~ property lines Give street and block numbers or description according to deed, and show street names and indical whether interior ar corner lot. STATE OF NEW YORt~, .... ) ~ ~ COU~,/OF .......... ~.~T..~. lt.~..~ ~_ · "...~.J~.....~~;.~.~ ..................... being duly sworn, deposes and says that he ,s the applic -"- (Norr)e. Jof_t.I individual signing application) above named.',~J~ is the ................................................................................................................................................. (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and thts application, that all statements contained ~n this application are true to the best of his knowledge and bel and that the work wdl be performed in the manner set forth in the appgcatlon filed therewith. Sworn to before me th~s ! ~ 19..~ / Nato ~ Pu,~b,i'c, ... L ~..~:~.~....~..~ .... County ~ignature of applicant) ........... L .ii *;.'o u '~..,:o ,:~ -.. ~. ¥. . : -..~ ...... MEMBER O~ THE ~ERICAN INGTITUTE OF ARCHITECTS CH~=~D 'W~OJEb~ ,'~ $ERAFIN SOTO, ARCHITECT ,, ~--DE~IDENC;G FO~ ~ ~ ~::~ 14. PI [CINGKI OIITI~O1.D N.¥,~ MEMBER OF THE AMERICAN INSTITUTE OF ARCHITECTS SERAFIN SOTO, ARCHITECT iI FEO'~T