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Home My WebLink About4105-zTOWN OF SOUTHOLD SUILDING D~--PARTME HT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. OE:RTIFIOATE: OF OOOUPANOY No. ~-.334S .... Date ........ MK.. 17., ....... 19~1. THIS CERTIFIES that the building located at .$~h'~d. Oo~ah. Drlla~ ........ Street Map No ............. Block No ............. Lot No. ~l~tll~ll~k,. b..~ork ......... conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ..... ~iI~1~...28, ...... 19. dated .... .0~,I~11~11:.. 18, ..... , 19.~8., was issued, and conforms to all of the require- merits ,of the applicable provisi.ons of the law. The occupancy for which this certificate is issued is .pt.:IV&tO. on& .f~tllt.. ~elJ.~.~ .wl~ .addition ........................ The certificate is issued to . .~rl[81l. i~181~llt~ .................................... (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval ......................................... ....... / .~..~i. 1.d.~.'~ ~':..~n ~ .p~'~ ~!'~ · ]~ .' .~.(. ....... ]POEM 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) 4105 Z Dote ........................................................ , 19 ........ Permission is hereby granted to: ~, /~-'"~0 ~,~,,~0 ~/~:~0''~ ..........................................................................~'~o '~ou~/'~ ~nc~ O~ v'E at premises I~ated at ............................................................................................................................ ............................................................................................ ~.4..~.L.~.~..~ ................. ~ ~ oc ~,,..~_._~.~?~o~ ~,~ pursu~ to opplJcotion ~ted Building Ins~ctor. Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Disapproved o/c ................ %,..~,~......~...,;..~... ............ ...~xw......; ............................. (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date .......... 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 or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of this application. c. The work covered by this application 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. Such 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building In.sp~tor. APPLICATION IS HEREBY MADE tO thee Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Towr~f Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable lows, ordinances,~tilding code, housing code, and regulations. (Sig~'t~u~'~f applicant, or name, if a corporation) ' (Address of applicant) \ c State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Nome of owner of premises ................................................................................................................................................... If applicant is 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 ........................ [~.. ........................................................... Mun cipo, I 2. State existing use and occupancy of premises and intended use and ~cu~ncy of propos~ construction: o. Existing use and ~cupancy I / b. Intended use and ~cupancy II 3. Nature of work (check which applicable): New Building ~ ................ Addition .................. Alteration .................. Repair .................. Removal ..... : ........ .:.. Demolition .................. Othe~ ~(ork (Describe) ........................................ J~Z Fee ~ 4. Estimated Cost ........................ /. ....................................................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling 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. Dimensions of existing structures, if any: Front ............. .~.....~. ...... Rear ........~......~.. ................ Depth ...~ ...... Height ........................ Number of Stories .................................................. ~L~..~; ................ ....- ....... .}.~:y.:y- ........... Dimensions of same structure with alterations or additions: Front .................................... Rero ........... .."':~.... ~'~ ............. Depth ................................ 'c~) Height ........ Z..~...Number of Stories ......... ./. ..................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ................... ~ ..................................... :'"LZZ~ .............................................. 9. Size of lot: Front ........ ~....~:...~..'~.. ..... Rear ........ ./....'~....~ ................ Depth ............ /...~. ....... ..-~..... 10. Date of Purchase ........................... Z'.~....~......0. ......... Name of Former Owner ....... ..~.t~t'..~..'~-----~......~.~/~...~.......~.~.... 11. Zone or use district in which premises are situated ........... ~.~.~.....~ ...... ~.~..'~...'~.../...~....~....~.....?./..../~.......~:~... ................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ ................. 7; ........................ 13. Name of Owner of premises ..~..........~..~..~..~....~....~...~.....0'~.....Address ..~'..~..~.....~..~..~...~....T.~...~....~.... Phone ~o.~..~.....--..~....~....~.. Name of Architect .................... ..~....... ....................... Address ............................................ Phone No ..................... Name of Contractor ......................... '~} .................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ ~f .... ,.~.~..,~ I~ ~/'"~O_~ being duly sworn, deposes and says that he is the applicant .................. ................. above named. He is the ........................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application/~led therewith. Sworn to before me this ............ of ..... . _ No,a ...................... MARION A. v (I NOTARY PURLtC, State of New ~ tj No. 52-3233120 Suffolk Tm'm Expires March 30, 13.~ 7