The URL can be used to link to this page

Home My WebLink About3938-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDo N. Y. CI:'RTIFIP. ATE: OF OCr. UPANCY No. ~. ~81... · Date ....... l~]~... 3,'~, ....... , 19~8. THIS CER'r~iES that the building located at .. Baltv:Le~ .itomd ............. Street Map No ............. Block No ............. Lot No... ~ol~ml41,. i~ .YO~X ......... conforms substan'dally to the Application for Buil~ling Permit heretofore filed in this office dated ..... ~.tlllr... 3., .........., 19 68. pursuant to which Building Permit No. ~938..Z. dated ..... 0'III. Ir...3, ........... 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 ...prtva~.~. one..£mm:Ll¥..dwmXllmc~ .w Lth. &dd:Lt ton ...................... The certificate is issued to ...... John. CZe~tO~I8 ...................................... (owner, lessee or tenant) of the aforesaid building. / , Suffolk County Department of Health Approval ...... ~ ~. !.~..' ......................... FORM 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) 3938 Z Dote .................................. ~.. .................... Permission is hereby granted to: at premises located at ~,/~ P~a2view Road 8ou'~ho:Ld, pursuo:nt to application doted ~'"0'~y 3 19..~..~.., and approved by the Building Inspector. Fee $.. ~....~ ............ Building InspeCtor TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~e~i ............. i~ ]9...~...,. Permit No. ~......?....~....,.~....~ Disapproved a/c ..................................................................... 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. PlotiPlan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giylng a detailed description of layout of property must be drawn on the diagram which is part of this application. c. T ~l~work ~Vered by this application may not be commenced before issuance of Building Permit. d. UIC~n opiC°Vol 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 burl'ding shall be occupied or used in whole or Jn part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of 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, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building cod~,~ housing code, and regulations. (Signature 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 ............ ..~t..~....~... ........... .C. ~..~,'~..~..~......~..-~ ............................................................... If applicant is a corporate, signatu~ of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. N~ap No.: ........................................ Lot No.: ........................ Street and Number .................... ~.y. ....... .~'../....~....~.. .......... P.~,~ ..................................................................... Municipality 2. State existing use and occupancy of premises and intended use end occupancy of proposed construction: o. Existing use and occupancy .......... .~...~..I..~'.~..~...~.. ......... ~...(~...~..~...~../...../~....~. ................................................ b. Intended use and occupancy .................. .~.~....~.....~.. ......................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Rer~a~t~ .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................................ ~ ( 7 ............. Fee ........... .................. 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 ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ................... Depth ................................ Height ........................ ./.~rnber of Stories ........ /...~.. .............. '~'~ 8. Dimensions of entire new construction: Front .~ ............... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... rl~pth ...~, .......................... 10. ~ ' . .......... Date of Purchase ........................................................ I>~e of~er ............... ~,~ .......................... 11. Zone or use district in which premises are situ, gted .................................................... ./..V~... ......................................... 12. Does proposed construction vi~l~Eo~ance or r~l~i~Lm~...'.:...~-..~ .................................................. 13. Name of Owner of premises/ ......................................../" n Address ......... -//~'-""/;')' ........................ Phone No ..................... Name of Architect ...... __'/~ ....... --/'"'~ ........................ Address ...O~~...L/Phone No Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oll set-back dimensi property lines. Give street and block number or description according to deed, and show street names and whether interior or corner lot. )ns from indicate STATE OF NEW ~i~JC~J ~ ~ ...... ....... .................................................................... ,.~ ......... /~ ......... ,~...being duly sworn, deposes and says that he is the applicant (Name of individual signing ap i~l:~,qi~](.~ ~ 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,~dll be performed i6'q~e rr~nner set forth in tF/e implicatig~fJled tJ~i~with,~ Sworn to befo~me this ~ I0 ~ , /~ ~ ........................ day of ........... ~ ............... ~. ........... , 19 ........ Notary Public, . ........................................................... County (Signature of applicant)