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Home My WebLink About3321-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE BF OBr. UPANP. Y No. Z 21046 .. Date. Apt.it 5:. , 19.~8 THIS CERTIFIES that the building located at .A.i~. ay D~ive Street Map No. Block No. Lot No. Mattitu.~k,...L: i.,.,.N,.U.: ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated NOV.,...15.,.. , 19 6.6 pursuant to which Building Permit No. Z. $.~.21 dated Nov, 19, , 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 lir:c~ .BuS..t.n.e.S.s...B.u.I.1..d.lp, g .~...Ofl.~.i~.e ......................... The certificate is tssued to .. C.: .H.,..~.i..0~..h..~¢B. .............................. (owner, of the aforesaid building. Suffolk County Department of Health Approval /q~r, Building Inspector / 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? 3321 Z Dote ........................ ~embe~.....],.9.., 19.~.. Permission is hereby granted to: ............ l~.t~uc~..&~r...~asa..;Luc ............... ..................... $~tt.$t~ek.~..#,.Y., ...................... at premises located at ....W~.J[....IB~ 3L~IiI~...D~ ...................................................................................... ............................................... ...!~$..1; $.~...uc..k~...~.,..~., ............................................................................. pursuon¢ to opplicotion doted .......................... ]~.,......'1.~. .............. , 19~..., end opproYed by the Building Inspector. Fee $."~.,OO ........... NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....................... .t..~ .............. , 19 ........ Permit No ................................. ~is~pproved a/c ....... ......................... ~ ...... ~'~~ullding l~pec(or ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s application must be completely filled in by typewnter 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 adloming premises or public streets c areas, and gwing a detailed description of layout of propertymust be drawn on the d~agram which is part of th~s applicatior c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding Inspector will issue a Building Permit to the applicant. Suc 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 untd a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to tF Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as herein describec The apphcant agrees to comply w~th all apphcable laws, ordinances, building code and regulations. (Signature of apphcant, or name, if a corporahon) (Address of applicant) State whether applicant is owner, lessee, agent, architegt, engineer, general contractor, electrician, plumber or builde ............................. ..L..e.~.~e.~ .................................................................................................................................................... Name of owner of premises ....................C:..-...~..*....W..J:~.k...~...m. ..................................................................................................... If applicant ~s a corporate, signature of duly authorized officer Jo Parker Wickham l~esident (N~me and t~tJe of corporate officer) 1. Location of land on which proposed work will be done. Map No' . ...........................................Lot No: ................. Street and Number ...... ~.W~r. ,I~.~j,~.e ....... ..[~. ~t,.~C~;,...~.e~.~g~, .............................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Ex~sting use and occupancy ............. .O.[~.i.¢.~...~..~...d..,Ijl.t.9. g,k...,~.9..o..m.. ......................................................................... b Intended use and occupancy ............................................................................................................................ 3. Nature of work (check which applicable). New Building ................. Addition ........ ~ ....... Alteration ................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4. Est,mated Cost .............. $20(~;~]~) ............................. Fee ......................................................................................... (to be po~d on filing th~s apphcation) $. 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, specffy~n~oture and extent of each type of use '"~i'ce"&'~t~c'~ 7 DImens,ons of existing structures, if any: Front ...... :x.~z'*~.~,l~'4z~ ...... Rear ....~-;.?M~'~ ........ Depth ....... ~.~..~ .......... Height ....... ~..5.~'t., ........... Number of Stor~es .............. ~ ......................................................................................... D~mens~ons of same structure with afterat~ons or odd,tions Front ......... .~..,.%. ............... Rear ...... ..~...~ ............. Depth ........ :..911....~.. ............. Height ....... ./...~.. ................ Number of Stories .............. /.. ....................... 8. Dimensions of ent,re new construct,on' Front ......... .~.....~... .......... Rear ../..~.....f....~,..~.. .... Depth ........ .~9~.....~. .......... Height ......... ./....~.. ............ Number of Stories .......... ~ .......... 9. S,ze of lot' Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... ]1. Zone or use d~strict in which premises are s~tuated ................ ..t~ ............................................................................ 12 Does proposed construction wolote any zoning Iow, ordinance or regulat~on~ ................ t~l~, .............................. 13 Name of Owner of premises ....~I~.~.;..9/~.~r~ ........ Address ...i~t~/~¢~.i..i~.~.¥.v .......... I~hone No. ~'IA:'9~,I~) Name of Architect ..................................................... Address ........................... 2 ............... Phone No ................... Name of Contractor .................................................... Address ............................................ P~none No ................... PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro, property hnes Give street and block numbers or description occordMg to deed, and show street names and mdico~ whether interior or corner lot. STATE OF NEW YORK, 1 S.S COUNTY OF .......... S~I,'~I~¢. ...... 2///////, ...... .d..:..P..~..~.~y...:}~,f:lCJ~m. ....................................................... being duly sworn, deposes and says that he is the applic~ (Nome of individual signing apphcation) above named. He is the .......... ~:~Lcl,~nt,.ctl'..N~t,t. it.~ei~.~,i.~.l~,s~.,..~¢ ..................................................................... (Contractor, agent, corporate officer, etc.) of so~d owner or owners, and is duly authorized to perform or hove performed the said work and to make and this opphcation; that oil statements contained m this application ore true to the best of his knowledge and beh and that the work w~ll be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ ~ / .......................... day of ........... ~.o~rembe~r .............. , 19..~.~, ./_.~- ,,,/ ~ / - / ........................