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Home My WebLink About4117-zFOI~M N~O. 4 TOWN OF SOUTHOLD TOWN CLEEK'S OFFICE SOUTHOLD, N. Y. P. EI~TIFIP. ATE OF OE:E:UPANI~Y No. Z. 3.373 .... Date ........ D~e,,~,ml)er...17o ...... ,1968. THIS CERTIFIES that the building located at Fa~B.Road ............... Street Map No ............. Block No ............. Lot No... ~l(at:.t~i~u~]~.~..N~,~. ¥o~'k ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~O~.~r..~, ..... 19~8]~ pursuant to which Building Permit No. 4.].17. dated ...... ~W~O.~:.(~., ...... 19~, was issued, and conforms tn all of the require- ments ,of the applicable provisions of the law. The .occupancy ~or which this cortificate is issued is .... p=~.vate..garage. (accessory. bulldll~g) ............................. The certificate is issued t,o .. ~.0111l .Lert~h&~ .......................................... (owner, lessee or tenant) of the aforesaid building. Suffo]k County Department of Health Approval .../ ........... ~ ........................... / i / / /~ · ...... ~ Building Inspector / FORM NO. '~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~117 Z Permission is hereby granted to: ........ ~T~.,~,~ ............. ............................. .......... ~t, ~;.~, ............................................... to ... ~.....~...~.d..~:l:.;Lox~...~.. ~r~..ez/a~/n~.. ac e,e sso~...bu~l~.. ,(.1~.t:.. ~g~ ) at premises located at ............ .~.~...~.~ ......... .~.J.~..~.~..~.:~.~.~.,q~ ........................................................... pursuan,t to application dated ..................... ]~,O.~: ......... .~. ................... , 19~..., and approved by the Building Inspector. eee $.~. ~.~. ............. ...... ...... FOI~M NO~ 1 'T~VN 0~: $OUTHOLD BUILDING DEPARTMENT TO~N CLERK'S O~ICE 5OUTHOLD, N. Y. .................. ................ : ......... APPLICATION FOR BUILDING PERMI*~ ¥ Date ............................. ~.O. ......... .6 .............. , 19..~..~. ...... INSTRUCTIONS o. 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 diagi'am which is part 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. SucJ~ permit shall be kept on the premises available for inspection througkout 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 Occupc(ncy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 code, end regulations. ............. J~bt~.,~n~h~ ..................................................... (Signature of applicant, or nome, if a corporation) .............. ~.t.~i~:~ak ............................................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................................................... *g~.l~o *~. .......................................................................................................... Nome of owner of premises ........ ,*J~Ohi0,**I.~.~t':l~l~,~.I~** .............................................................................................................. 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 ...... ~:~'~,L~¢Oax~ ................. ~?~t~.t~l,.~-~,,i~ ................................................................. ~ ................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ¢j~/a:j.-]:.:j.~p.~¢...ga.z,a.~ ........................ ~ ....................................................... b. Intended use and occupancy .. . ,,~.....-,,.m.~h ~I:~ ..~a-g,&.~.~,a~...t,~..i~&~.&~ ....................................... 3. Nature of work (check which applicable): New Building .................. Addition ...... :]r~ .....Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............................ ~OO..~t, .................... Fee ..~.,..O.O. .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units .....~..o..~.e. ............... 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 ...... .1L)~,,2, ............ Rear .......... .1..bt,,.2 ............ Depth .......1.c),,~ .... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .....8.. ............................. Rear ....... .~. .................. Depth ..1,.0,.',.,6. ............. Height .................... Number of Stories ..... O~. .......................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ ]0. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ....~.!~tJ...~ls.t, .............................................................................. 12. Does proposed const'~uction violate any zoning Jaw, ordinance or regulation? ............. ~O .......................................... 13. Name of Owner of premises ..... ~.O]¢~..,l~e~&~.&~.....Address ............ ~.t,~Lt. lJ~7,1~ .......... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...............S.~I,~e ........................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines, Give street and black number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~ Y,O, BY,.,~ '~ S S COUNTY OF ..B~.z..o..~ .............. ~ .. .......................................... ~.gt~'~J,...~..~l~(I.~l-.~l,.~ .......................... being duly sworn, deposes and says that he is the opplicant (Name of individual signing application) above named. He is the .............................. .o.~.e..~...-....~.~.~..e..z'.. ...................................................................................... (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 filed therewith. Sworn robe fo re me this ..... ~~(~/~ ~ ~_ ................. .6.... day of ........... [.Q~.~.~!..~.~.~' .............. , 19..~.~.. Notary Publi~.~...~.~. County ~ (Signature of applicon0 ~. MARION A. REGENT .. ~.~.,, NOTARY PUBLIC, State of New No. 52-3233120 Sutlolk Term Expires I~r~h ;~0~