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Home My WebLink About4135-zFOR~ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT '~"OWN CLERK'S OFFICE SOUTHOLD, N. Y. CEI~TIFIEATE OF OOr. I~t~ANO¥ No..Z.. ;~.3, 8.0.... Date ........ .D, ecerabe~,,..~ ,7 s ....... 19.6.8., THIS CERTIFIES that the building loc.areal at bIO~.~;~. ~al,..tO .Ba.l~'vi~,~: . ~Sr~reet Map No ............. Block No ............. Lot ]No. SQllthi~lc~..~o.Y .................. conforms substantially to the Applicati,on for Building Permit hereto~(~re filed in this office dated ..... .N.Q.v.~..1~..e.~...2.0., ..... 19.6.8.. pt}rsuant to which Building Permit No...4.$.3.5..~ dated ..... .~I.QV..~.lll.b..~..2..0., ......;19.6.~. ., was issued, and 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 .... l~.~.i.¥.~t;..~..~.~.qe~.C}~y'..]~l.;t,],d,tla~[. ........ ................................ The certificate is issued t~o ..... W..a.~..t.e.~..~.cl~.ule.~l~ ..................................... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval .......... ....~. ........................... Building ~ Inspector t FORI~ NO. 2 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? 135 Z Permission is hereby granted to: ............ .~ex..~dams~ ................................. ........................ ~.~e,~b,~ ~ .................................... to ~..~.e.~ .~..e..o..e..~.s...o...~...~..~.~.!..~.~ .... at premises located at ........... ~/~.....No~.t~..~le~..~o~..&.~...Pr_~...t~..~ ........ .......................................................................... ~o~thol~ .................................................................. pursuon¢ to application doted ............................... JJ~t ........ ~I~ ......... , 19~1~..., end approved by the Building Inspector. Fee $, ~'.~.t~) .............. Building Inspector 'FORM ,NO. 1 TOWI~ OF SOUTHOt'-D BUILDING DE~ARTMEI~T TOWN CI~RK'S OFFICE SOUTHOLD, N. Y. Examined .: ?,..,.;.., ,~ . ., 19,,;,. Approved ..................... i[9 .... Permit No.. .~. ~ ........ Disapproved a/c .................................................... ....................................... ' 222 ............. ................ /...\ .... [. ~..~.-'. · ;.: :. & ...................... (Building Inspec~r~r) APPLICATIO,~ FOR BUILDING P~RMIT Application No ................. Date ............. .~.oy.e.$]o.e.¥....~.0... 19..68 INSTRUCTION. S a. This appl/cati,on must be completely f/lied in by typewriter or in ink and ,submitte~d in duplicate to the Building Inspector. b. Plot ]?lan showing location of ~t and of buildings o n premises,: relati~onship to adjoining premises or public streets ,m' areas, and giving a deiailed description of lay out of property must be drawn on the diagram which is part of this application. c. The work covered by this applicati,~n may n~t be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to t, he applicant. Such permit shall be kept ~vn the premises available for inspectio~ throughout the progress .of the work. e. No building shall be occupied or used in whole ~i~ in paget f~o~r any pur[~ose whatever until a Certificate ~cfi Occupancy shall have been granted by the Building Inspect~or. APPLICATION IS HEREBY MADE to the Building Department fo~ the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of So'uthold, Suffolk ~o%mty, New York, and other applicable Laws, Ordinances .or Regulations, for the construction .3f build ings, additions or alterations, or ~or removal or demo- lition, as herein described. The applicant agrees t,o corn ply with all applicable la~vs, ordinances, building code, housing code, an,d regulations. ~l.t.e..r./~t$~...~dm~son .................. (Signature .cfi .applicant, or name if a corporation) .... iiocth. 2;a~.~.te~. i%oad .... ~outbold- .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contract,~r, electrician, plumber or builder ............. 0~,~.~: .-..~,~+~(,,~ ~ ~ r~.:~ .... ..... · .......................................................... Name .of ,owner of premises .., ~q~L:~er..:~.~...A.~,ll~-~lf~Oll ....................................... If applicant is a c~rporate, signature of duly auth,orized ,c4ficer. , (Name and title of corporate officer) 1. Location .of land ,o.n which pr(~p.o.sed work will be done. Map No .... ~ .......... Lot No.. ~ ......... Street and Number ........ t~:~.~f ~ .... .tto~i..t:~. ~ay~tew..&. 8~;Lv. at~ ,!,ih~umc~pahty ~' "'" ": ...................... 2. .State existing use and ,gccupancy ,of premises and intended use and .occupancy of p~posed construction. a. Existing use and occupancy ..... t~.~. . .] ...................................................... b. Intended use and ,occupancy .... ~¢~t~,~. .w.i.~h .~r~ .~o~ee, s~:~y.buitSt~6 ....................... 3. Nature of work (check which applicable): New Building Y, JC~ .... Addition ........ Alteration ........ Repair ......... Removal ........ Demolition ........ Otb.er Work (Describe) ...................... 4. Estimated C~.st ...1~711.2 ....................... Fee . .~.fl0 .......................................... (to be paid ,3n filing this application) 5. If ,dwelling, number ,of dwelling units . r~Ol~e... Number .of dwelling units on each floor .............. If ~arage, number .eft cars .......................................................................... 6. If business, commercial ,~r mixed occupancy, spec ify nature and extent of each type of use . ...A.e.e..~.s.s..0.~.~' 7. Dimensions of existing structures, if any: F~ont .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions .of same structure with alterations .or additions: F~ont .............. Rear ............... Depth ................ Height ................ Number of Sbo~'ies ..................... 8. Dimensions ~of entire new construction: Frant .... 12 ........... Rear . ..]2 ........ Depth . .~.~ ........ Height ............ Number ,cT S~ories .. ~)~.e. ....................................................... 9. Size of l, ot: Front ................ Rear ............... Depth ............... 10. Date of Purch. ase ............................... Name ~f Former Owner ............................. 11. Zone .or use district in which premises are situated... !~A~.~. .dis.t ...................................... 12. I]oes proposed construction vi,olaie any z3ning law, .ordinance or regulati,~n? ...... 1~0 ................... 13. Name ~of Owner,of premises .Wa;],tel~..Ad, aln$o~.. A, ddress ...,qouthold ......... Ph,~ne No ............ Name of Architect ............................. .~ddress ...................... Phone No ............ Name .of Contractor ...$&l~ .................... Address ...................... Phone No ............ PLOT DIAGRAM Locate cl.early and distinctly all buildings, whether existing or .proposed, and indicate all set-back dimensi,ons from property lines. Give street and block number ,~r description according to deed, and sh.ow street names and indicate wheiher interior ,or corner 1,ct. STAT]E OF NEW YORK, )S.S. COUNTY OF .~Uf. fol~ .... ) ....................... · Walter. AclamS(~ll .......... being duly sworn, ,deposes and says that he is the appli- (Name ,of individu, al signing applicati.on) cant above named. He is the Owner - builder (O~ntractor, agent, cm~p,orate officer, etc.) of said owner ,or ,owners, and is duly auth,orized to pe~3rm or have per~orme.d the said w,~rk and to make and file th~s applicafi.on; that all statements contained in this applicati,on are true to the best of his knowledge and belief; and th.at the v~rk will be perfo~ed in the mann er set ~,~rth! in the applicatio,n filed therewith. Sworn to before me this ............. 2.0 day .of ....... I~o,,t ........ 19.6~ N, gtary ........ ~'~o. 52-0618100 Suffolk flount~ Commission EXpLres March 30,