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Home My WebLink About3307-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. EI~TIFIP. ATE: OF' rlI~P. UPANE:Y No. ~; 303~.... Date .. ~.P~.i], 4, ...... ,19~. THIS CERTIFIES that the building located at ~ l~ive .......... Street Map No. Block No. Lot No. Ct~tt~,h.~l.~ I~, .~.., .1~,.~ ...... conforms substantmlty to the Application for Building Permit heretofore filed in this office dated ... lily'S.:. 8 ..... , 19 ~. pursuant to which Building Permit No.M 330'/. · dated l~/ov: 9 . . ., 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 p~vate .~l~.e .~!:I,F..~.e .1),tn.~[ ................................. The certificate is issued to ....... ,~ohr,. ~aaO ............................... (owner, lessee or tenant) of the af(~resaid~ building, o£ Health ~.-- '. !.(""~. Suffolk ~.?unty Department Approval .. . ...... (' ' ....... FORM NO. 2 TOWN OF $OUTHOLD 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? 33O7 Z Permission is hereby granted to: ...... ~,'t d.~la~'.. &.. ~to~.toa.. ,~f.~... J~tm.. ~ s~o to ... ~ ~.. ~.. ~ ~ g~.. ~...~...~.~ ~.. ~r~.~ ~.~ ................................................... at premises I~ated at ...0~..~ ................................................................................................... ......................................... ~t~pet..E~-., .................................................................................. pursuon~ to application dated ............................. ~0~,.....~ ............. , 19.~6.., and approv~ by the Building Inspector. Fee $..~.e. OO ............. /' NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........... ~...~.......~ ......,19..~..?.. Approved ........................................ , 19 ........ Permit No ............................. APFLICATION FOR BUILDING FERMIT INSTRUCTIONS a. This application must be completely filled ~n by typewriter or fn ~nk and submitted in duphcate to the Buildint Inspector. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or pubhc streets o areas, and gwing a detailed description of layout of property must be drawn on the diagram which is part of this application c The work covered by this apphcat~on may not be commenced before issuance of Building Permit. d. Upon approval of this apphcation, the Building Inspector will issue a Building Permit to the apphcant. Such permi 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 part for any purpose whatever until a Cerhficate of Occupano shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Building Department for 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 Regulations, for the construction of buildings, addmons or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable ~ows, ordinances, building code and regulations (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, ................. &~.~.~..~,.,O.Q~.~.~.Q~. ................................................................................................................................. Name of owner of premises ................~..^kT. QJ:;Ug...~.~f;) .................................................................................................... If applicant is a corporate, signature of duly authorized officer .................................................................................. ) (Name and title of corporate officer) I. Location of land on which proposed work wdl be done Map No · · ....................................... Lot No: ........................ Street and Number ......... Q.~.~.i~. .................Q~g~Q~.,...~...~Q~ ...................................................... Munici~lity 2. State ex,sting use and occupancy o~ premises and intended use and occupancy of proposed construction. a Existing use and occupancy .......... ~i~.~.%.~..~.~l~OD. .............................................................................. b. Intended use and occupancy ....... ~I~.~.~...~e.~.~Q~. .............................................................................. 3 Nature of work (check which applicable): New Building ................ Addition .....X ......... Alteration ........... P, epair .................. Removal .................. Demolition .................. Other Work (Describe) ............................ 4. Estimated Cost .........~0~0.~0(~ .............................. Fee .................... .~[,(~) ........................................................ (to be paid on filing th~s apphcat~on) 5. If dwelhng, number of dwelhng units ............................ Number of dwelling units on each floor ...................... If garage, number of cars ............................................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use .................... 7 D~mer, s~ons of existing structures, if any: Front ...~:L ................ Rear ............ ~TI ............... Depth .......~.~. ...... Height ........... ~ ........Number of Stories ............................. ~ .................................................................... Dimensions of same structure with alterations or additions. Front .......... J~,~ ..................... Rear ...... ~,~. ........... Depth ....... 2J~ .................... Height ......... ~ .............. Number of Stories ............. OJ:iL~ ........... 8. D~mensions of entire new construction' Front .......... ~ ..................... Rear ..... ~ ................. Depth ......... ~1~ Height "-4 ........... Number of Stories .................... ~:l.~ ........................................... 9, Size of lot: Front ....... ~.,~ ................ Rear ............... .~..,~ .............. Depth .......... ~'~(~ ........... 10. Date of Purchase ...~,C~ .......................................... NCme of Former Owner .. ~I~__~II.~:~.~R'J~I~ ...................... 1 1. Zone or use d~strict in which premises are situated A...~C~JJ .................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulat~on~ ............ ~ ......................................... 13 Name of Owner of premises .~T¢~1~..~8~ ............ Address .gl~t~..~.~t/~ ................... Phone No ................. Name of Architect ..................................................... Address ............................................ Phone No .................. Name of ContractorJ~t..&..~rO~'~l:l, ............ Address ....(J~¢~,41~tJ~ ................Phone No PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate ail set-back dimensions fror property lines. Gwe street and block number or description according to deed, and shaw street names and ind~cat whether interior or corner lot. O o--\< X. v- STATE OF NEW YORK, COUNTY OF ................................ t t I , l t_l.t ~'b~e of ,nd,viduat~n.~_g a~7l_,.?.~on)' 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 fi th~s apphcation; that all statements contained ~n this application are true to the best of his knowledge and belief, a: ,that the work will be performecl in the manner set forth in the application filed therewith Sworn to before me this, ",' ...... .C~.. :. ......... day of ._. ...... .... Not~ry Pubhc,~~.~....w.. ~n~ (Si~nnture of ~pplic~nt) Not~ Pubhc No, 52-7057]50 ~ I Res*drag m Suffolk County ~omm~s~on