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Home My WebLink About3328-zFORM NO. 4- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE OF' E]f2P. UPANr, Y No. ~; 2~01 .. Date . AU~l~t ~ . , 19 THIS CERTIFIES that the building located at S,/~. F. altl...I~.a..d ....... Street Map No. ~: Block No.X:~ Lot No. ~ .Clli;~-Jaogll~ i~X,... conforms substantially to the Application for Building Permit heretofore filed in this office dated i~OV.. 30 ~[966, 19 pursuant to which Building Permit No. 3328 dated l~r 30 , 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 ~ssued is CO.m~_~ el~c~l,..fl~ .z~l. 8.t;.at7~1. ~..eQ0~[.eR ................................ The certificate is issued to . .~.c~'l~U. W.i¢~ ...... .OW~ ........................ owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~[,~, ....................... Building lnsp~tor I FOILM 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? 3328 Z Permission is hereby granted to: .................. .q. ol~...~£ckaaa ................................ .... N~ir,..]/~ad, ...................................................... .................. C~toh~gae~...~.~., ......................... to ....~l.~..~U..a~.~o~..~..~..e~t s.t~u~..f~r~..hu~d~a~...(~.oa~d.e...~.~d~. at premises located at ...i~/.~_...~I~.J,D,..BOItJ;I ....................................................................................... ...................................................... ..C~....t..c. h .o. ~.~.~ .....N.....~.,. .................................................................... pursuam to application dated ................................ N~Vela~i~$t~.....~ 19.~.., and approved by the Building inspector. Fee $....~.0..0. .......... ' Building inspector / FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved i L 19...~...Perm~t No Disapproved a~.~ ................................ V(Building Inspector) ! APPLICATION FOR BUILDING PERMIT Dote ........... ./.~.~.~.. ~ ..... ..2z...~. ........... , 19...~.....~..... INSTRUCTIONS a. This application 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 buddings on premises, relationship to adjmnmg premises or public streets or areas, and gw~ng a detailed description of layout of propertymust be drawn on the d~agram which is part of this application c The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d Upon approval of th~s apphcation, the Budding Inspector wdl issue a Building Permit to the applicant. Such permit shall be kept on the premises available for ~nspection throughout the progress of the work. e No budding shall be occupied or used in whole or ~n part For any purpose whatever until a Certificate of Occupancy shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the censtruction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. (Si~ure of applicant, or name, if a corporation) ... , ........................ ...................... ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .................. ~ ... ~ .......... .%.[0..o...rye. ..................................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) 1. Location of land on which proposed work will be done Map No' . ........................................... Lot No' . ................... Street and Number ................. ~....~..: ................................................................. Municipality 2. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy .................... .~......m...~ ...... ~....~......: ........................................................... b. Intended use and occupancy ................. ..~.....z~...~ ...... ~....~........~.~.... {.~.. ~.]~ ........................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ..*. .............. Repair .................... Removal .................... Demohtion .................... Other Work (Describe) ..................................... 4 Estimated Cost .... /(~.T.e.~.. ~ ...................................... Fee .......................... .~....~..~..~.. .................................................... (to be pa~d on filing th~s application) 5 If dwelhng, number of dwelling umts ............... ' ............ Number of dwelling umts on each floor ........................... If garage, number of cars .................. : ..... w .............................................................................................................. 6 If business, commeroal or mixed occupancy, specify nature and extent of each type of use ...-~.~.~.:..'~.~: 7. D~mens,ons of exlst,ng structures, if any: Front ........ .~...4..~ ........... Rear .... ~....'~...~ ............. Depth ...~..~...~ ................ Height ...//4../.....r-~.e~. Number of Stories ................ I D~mens~ons of same structure w~th alterations or addibons' Front .......... 9.~.....'~r.. ............. Rear ..... .~'.....~. .................. Depth .......... ~¢ .............. Height ........ /.4Z...r...~..~umber of Stones .......... Y. ............................ 8. D~mens~ons of enhre new construction: Front ............................ Rear ............................Depth ........................... Height ............................ Number of Stories ............................ 9. S~ze of lot.. Front ....... ¢..~..~. ............. Rear ....~...°...!...~.~..,~-.~Depth .. ~ 10. Date of ~u~,Pc..~h~ ........ ~.~.~,.~..~ ........................Name of Former Owner .~...o...~..:.....f~..,:.c..(f.,6.,.~......~.~..: ] 1. Zone or use distnct m which premises are s~tuated ........................... ~ ................................................................. 1:2 Does proposed construction violate any zomng law, ordinance or regulation? .................. ~ ............................ 13 Name of Owner of premises .~b,x~../.~Z'~/.4..~'~zere~.Address ~z~.~..~...°..~..~.....%.. Phone No~2J..~'..7..C.~...~.../. Name of Architect ...................................................... Address ............................................ Phone No .................... Nome of ~.',~etor .~..~...:.z~.~...~..*'/~...g;/ ............ Address ...~.;.t'..~...~.~:~......,~t?..-. Phone No .................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether existing or proposed, and indicate all set-back dimensions fron property lines Give street and block n~ ~1 V,~±-. /Z~[ ~ number~or zles~.rtpt,on accordma ~o deed, and show street names and ind~cot STATE OF NEW Y.QBK, .~ ~-- "] ~ c. COU ~N~TY ......... / ........... .~Jg¢~z..~~~.~ ................................... being duly sworn, deposes and says that he is the apphco ~ (Name of individual signing apphcation) above named. He is the ........................................................................ ~~ ...................................................... (Contractor, agent, corporate officer, etc.) ~ sm~ow~r or ~ners, and is duly authorized to perform or have performed the said work and to make and f this opphcotion, that oil statements contained in this application ore true to the best of his knowledge and bell and that the work will be performed in the manner set forth in the apphcation filed therewith. Sworn to before me this ~ ........ z~,,~ .......... ~y ........... AFl ,~ jACOBS ~ ............................. ~ ,. , ........... . ............ ............................ otory P.bhc. Co ty (S,g ot e of oppli:o t)