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Home My WebLink About4032-zTOWN OF SOt~'rl'/OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. [::E:RTIFIP-ATE: OF OGP. UPANP. Y No..~3~. .... Date ............... l)~*=eabe~... 9.., THIS C~TIFI~ that the building l~at~ at . ~...~a~e~se~e. ~a~. .... St~et Ter~ ~aterl Map No ............. B]ock No ............. Lo~ No. ~ .... ~t~l~-..~,~, ........... co~o~s substanti~ly ~ the Application for Building Pe~it he~tof~ ffl~ in this office dated ......... Sep~ .... ~ ...... 19.6f~p~u'ant to whi~ Bulldog Pe~it No..~.. dated ............ ~ .... 6-', 19. ~ was issued, and conforms to all of the require- men~ of the applicable provisions of the ~w. The .~cupancy for which th~ ce~fficate is i~u~ is ~wl~a~ .one. f~.ly, d~l~ ........................................... The ce~ificate is i~ued ~o .~dg~.D.~. ~. ~4~ ..... ~e~ .................... (owner, lessee or tenant) of ~e ~or~aid building. S~olk Co~W Depa~ment of Health Ap~val ..... ~ ............................... FOR~ 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? 4032 Z Permission is hereby granted to: .......... hCh.~r~,v.....~C.....a4p3~..~. .......... ~....3~1 ....... &~ ..................... at premises located at ..... ~4~t~.....~. ...... .~3~..jg~t,e,l~J ..................................................................... ........................ a~.B.....~xt, eza..~,d~,ava~r .............. SoGt~ld, ........................................................ .................................. ~j~ ......... ;~...., 19...6~, and approved by the pursuan¢ to application dated ': ' ~ Building Inspector. Fee $..~...e...0~.., ............. Building Inspector / TOWN OF SOUTHOLD ,,~ BUILDING DEPARTMENT ~.,~c..,,._ TOWN CLERIC'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ..... ~ ................ APPLICATION FOR BUILDING PERMI1 .............................. , 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 building~ On premises, relationship to adjoining premises or pu. blic streets or areas, and giving a detailed descriPtion of layout of property must be drawn on the diagram which is port of th~s application. c. The work covered by this application may not be commenced before issucmce 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 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 removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing cede, and regulations. '(Signe~Jre of applicant, or name, if o corporation) ....... (Ac~:lress of apl~ant) / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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~..~¢'....~.~..~.~....~ ....... ,...~1~..~,>o ..................... 2. State existing use and occupancy of premiss and Lntended use and occupancy of proposed construction: a. E~isting us* and occul~ancy ..... ........................................................................................ b. Intended use and occupancy ,,~.~..d~w~,c.~,,~w~ ...................................................................................... 3. Nature of work (check which applicable): New Bdiiding ] ................. Addition .................. Alteration .................. Repair ................. '7/U4~J:n°v~al(-~t ................. Demolition ............. :.... Other Work (Describe) 4. Estimated Cost ............................................................ Fee ...~.. 0 o 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, ~s~ee~fX nature and extent~ ~acl~ type of use .....~.~. ........... 7. / '~ / '~ Depth .................... Dimensions of existing structures, if any: Front ~.~~ ................. Rear ................................ Height ........................ Number of Stories ...... ' .................................... -- ~ ~..~'~'"'~"~"~'~';"~"~x ................. --~ ~-~'~"~'""~'~:"~' Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height .................. 8. Dimensions of entire new construction: Fron,t ~:_....: .......................... Rear ............................ Depth...~ .................... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction v~__~ ~i~n~l~/~,¢w,~clinance.j~regulation? ............................................................ 13. Name of Owner of premises-.~...~..¥..~ .................... '..~...Address ............................................ Phone No ..................... Name of Architect .x:/ ........,~ ...... ~ ........................... Address 4~......:~:~.~,...../~ ...... ./J ......... Phone No>/ Name of ~ontractor ..~.,.~.. ............ J .............................. Address ..; ................... .~Z.Z....(~I'....; Phone ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all 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 ................... ..~.....~..'.......'-~....~ .................................. being duly sworn, deposes and says that he is the applicant c_.j ( Na me of ,nd ividua, s~lo~i~.~..b~at~i~ above named. He is the ......... ~.~.~.~.~...~ ......................................................................................................... (Contractor, agent, comorate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~:ke 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 fo~h in the application filed therewith. Swam to be~ore me this ....... o, Ho. 52-3233120 Suffolk ~unt~ Te~ ~pires ~rch 30, 1~