The URL can be used to link to this page

Home My WebLink About3950-zFOBM NO. 4 TOWN OF SOUTHOLI~ BUILDING D~-PARTMERT 'I'OW~ CL~RK'S OFFICI SOUTHOLD, N. ¥. EEI~TIFIEATE OF rlEI~PANI~Y No. Z. 3.379. .... Date ...... ~..9.e..c.e..mb.e.x...3,7, ....... ,19.68. THIS CERTIFIES that the building loc.ated at ~.~l;e~.lS .~ClilI~..Way. ........... Street Map No..~...2.9.1..0 .... Block No ............. Lot No.56.,..Ba¥. conforms substantially t.o the Applicati,on for Building P~rmit heretofore £iled in this office dated ........ 0'.tlJ~y., ..... 5 o ..... 19.613. pursuant to which Building Permit No...3 9.50. dated ........ ~.tl.J-.y. .... .1.~.,. ..... 1961il., xvas issued, an? conforms to all of the require- ments ,of the applicable provisi.ons of the law. The .occupancy f. or which this certificate is issued is . ~.:[.v. ii.t:.e...o, t3e..t~are0,3,y...d~.~J, Jc,t,nit..wi,th. alldl[t:;I.oll ....................... The certificate is issued t,o ...C.h..a.l:.3,.e.~...A~.h!i.o.w. ll~..~.,. ............................... (owner, lessee or tenant) of the aforesaid building. /~,/ }~ , ,Suffolk County Department of Health Approval .......................................... FORM NO. 2 TOWN OF $OUTHOLD BUZLDING 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) 3950 Z Permission is hereby granted to: ...... .~ree~...~.....4.~...~t~a.A~w~ ..~ .............. ~.een~'.t. ......... ~,:[~ ....... ! ................. pursuant to application dated .............................. J.~;~.....~' ....... i4..., 19.,~J., and approved by the Building Inspector. 3OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ~9 ........ Permit No ..................... D, Disapproved a/c ............................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submiffed in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining pr.emises or public st.reets or areas, and giving a detailed description of layout of property must be drawn on the diagram which ~s part of this apphcation. 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 ·holl have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a 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 remova or demo ition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. % _ .......... ........ ................................... ._ (~i~nature of applicant, or name, if a corporation) ............. ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, eng'neer, 'general c~ntractor, electrician, plumber or builder. ..................................... ~.e.n.e~l...C.o=~rac.~.or. ................................................................................................................ Name of owner of premises ~'~.~'. (~hase ~, Aabdown dZ', & ~].~Z* ~T, ~'~ 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.: ...~,1).11~.~. ......................... Lot No.: ..~. ................. Street and Number ...... .~..a...~..e~.~..e.~.e.....~...~:~...s..~...]~..~.~....]~...?..e..~.~.;..~..~..~...~.~.~..~.~.~..!...~7. ....................... I ~ [ ~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .D...~..?..]:.]:.~...a~... ...................................................................................................... b. Intended use and occupancy ......... ..~...~...e. .............................................................................................................. 3. Nature of work (check which c~oplicable): New Building .................. Addition ~.QZ'.Qb. ..... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... ~.~.(JO.o ....................................... Fee ...JJ~.0J~ ........................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .~,1].....,~1~ ........ 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 a.lterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction Front ...... .2..~..~. ....................... Rear............................20e Depth ....[...2.~ .............. Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed cdfi~t~'~/¢H6n ~/Jolate' any 'zOning law, ordinance or regulation.;> ............................................................ nre_i~e~ ~Z'. ~[ ~h(~O]ll~ ^~ _ 13. Nome of Owner of , ,. ~ ~ ........................................ r~ress ............................................ Phone Name of Architect ...................................................... Address ............................................ Phone No. 37~6 Nome of Contractor .......................... :i.Address No. PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions frc~rn p~'operty lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. / '¸1 STATE OF NEW YOR~,_ .._, .___ COUNTY OF ....... ....~. ~/.,~...... j S.S. ............................. · .'g/.,~...~"~'....;....;~..~g~./5'J ............................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............ ;..~~.~ ............................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is.dul~-aut~r~ed-to perform 'or have perfo~ed t~e said work and-to ~ke and file this application; that all statemen~ contained in this application are true to the best 0f his knowle~ge',ond belief; and that the work will be performed in t~. me,er.set -fodh.in the application' filed therewith. Sworn_~ ~ ~~~~~to before~ me this ... ............ R~it' Comm~s;c XA/AY C~As. E