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Home My WebLink About4150-zFORM NO. 4 ?OWI~ OF SOUTHOLD BUILDING DEFARTMEI~T TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. r. EI~TII:'Ir. ATE OF Qor. uI~ANr. Y No...~..33.~7... Date ......... De~elabe3~... i.Q, ..... , 19.68. THIS CERTIFIES that the building located at22.90. ~SigzbY. ~Oad ........... Street Map No ............. Block No ............. Lot No. ~:t::t.t;U~k,..}]em .¥~3rk .......... conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ....... D~celo~l~e:l:... :LO,., 19.68 pursuant to which Building Permit No..4].,~0. Z, dated ...... .De~emlO. e~:...~.0.~.., 19..68, was issued, and conforms to all of the require- ments .of the applicable provisions Of the law. The .occupancy f. or which this certificate is issued is ,.. t~:. ~po:~.t. l~ccaszo~y, ztr~¢~:u~e) .................................... The certificate is issued t.o ..... ~c&d.~o~l~J.r~J~..~$ .............................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......................................... .... Building Inspector FOILM NO. 2 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? 4150 Z Permission is hereby granted to: ............. ~:.~.:~:i::~..?. ......... ~.i/,-'..~.:~.!~:~/...~ ~ ~'~ ot premises .ocoted ot ............................ ,~...f7;;...'?..~. ........... ~.,/._.-.~,~..z.,~.../.;Z.X .......... ,/-~,..~...~.;./D. ........... pursuon4' to c~pplicotion doted .............................. ../...~......{.~.'.5:.~..~*....., 19.. ~.x?~ and approved by the Building Inspector. Fee $ ........................ Building Inspector ,FORM ,NO. I TOWN OF SOUTHOLD BUILDING DEPARTM,ENT TOWN CI~£EK'S OFFICE SOUTHOLD, N. Y. ......... /: ................ . . ~i~ow~ ~/~ .... ,.~~~-.~... .................... ....................................... ~ ~ ............... .. _ .................... (~ui~:ih}.~~.-' APPLICA~'IG,N FOR BUILDING p~:RMIT Date t"? /~'~-f~ 19,~. .~. INSTRUCTIONS a. This application must be completely filled in by typewriter on in ink and .submitted in duplicate to the Building Inspec~0or. b. P~ot ,plan showing 1,ocation of ~t and ~of buildings o n premises, relati,anship Go adj,oining premises or public streets ~or areas, and giving a detailed descripti, on of layout of ppoperty must be drawn .on the diagram which is part of this application. c. The work covered by ~his applicati,~n may n~ot be commenced before issu.ance of Building Permit. .d. Upo.n approval ~of this applicati.~,n, tile Building Inspec+~o~ will issue a Building Permit to the applicant. Such permit shall be kept ~,n the premises available for inspectien 'throughout ihe progress ,of the work. e. No building shall be occupied or used in whole c~ in part f~o~ .any purpose ~vhatever until a Certificate ~f Occupancy shall have been granted by the Building Inspecl~r. APPLICATION IS HEREJBY MADE to the Building Department fo~ the issuance of a Building Permit pursuant ~o the Building ~one Ordinance of the T~own of So~athold, Suffolk ©~unty, New Y, ork, and other applicable Laws, Ordinances ,or Regulations, for the construction .~f build ings, ad~litioim or alterations, ,or f,or removal or demo- lition, as herein described. The applicant agrees to comply with all applicable laws, ~ordinances, building code, h.~using code, and regulations. (Signature ,of .applicant, or name if a corporati.on) (Address of applicant) State whether applicant is owner, lessee, agent, architec[, engineer,, general contracbor, electrician, plumber or If applicant is a oorporate, signature of duly authorize d ,~fficer. (Name and title of corporate officer) Locati.on ~of land ,o.n which pr~po,sed work will be done. Map ,No~. ............... Lot No .............. ~unicipa~y / State existing use and ,~ccupancy ,of premises and intended use and ,occupancy of proposed eonsfruction. a. Existing use and occupancy ............. ~ ...................................................... ~ b. Intended use an,d ,~ccupancy .......... .~.~.~..~. · · ~-,-'~ 3. Nature of work (check which applicable): New Building ........ Additi,on ........ Alteration ........ 'Repair ......... Removal . Demolition ........ Oth.er~ ~ork (Describe) ...................... 4. 'E~stimated Ca.st .......... i'./.' .~.'.~.'i .............. Fee .... .~.~ ........................ (to be paid ,~n filing this application) 5. [f ,dwelling, number ~of dwelling units . . Number .of dwelling units on each fiG,or .............. If garage, number .o~ e~rs .......... ~.....~.~ .......... .~.~ ..................... ' ....... 6. [f business, eo.mmercial- ,.~r mixed occupancy, specify nature an~type of use .............. 7. Dimensions of existing structures, if any: Front .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions ,of same structure with alterations ~or additi.ons: Front .............. Rear ............... Depth ................ Height ................ Number of S~cqcies ............ entire new construction: F nt 8. tteight ..... .~. .... Number ,*f Stories ..... .~.~ ...................... 9. Size of ~ot: Front..../...~..O. .... Rear . ..~. .......... Depth ..... ./.~. ...... 10. 'Date of Puveh.ase .......... '~./.~..~.~..'?~r .........Name cf Former Owner ....... ~'-~ ~ ~../..~ ......... 11. Zone .or use district in which~/premises are situated ............... ~. ~ .................. 12. Does proposed con,struction vip~lBte any~nigg lgw, ,ordinance or rel~ulation? t .......................... 13. Name.of Owner.of premises ..~~~.g~ ..... ,~..,~..t~..~/..//.f/.~. Ph,ane No~?..~..-...Zf.~../~ iName of Architect ............................. Address ...................... Phone No ............ Name .of Contracl0or ...... . ...... ,,~,~-~t-------..... ........ .. Address ............ ----:.: ........ Ph,ome No."..w ........ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing .or 'proposed, and indicate all set-back dimensi,ons from pro,perry lines. Give s~reet and block number ,ar de script}on according to deed, and show street names .and indicate whe~cher interior ,or corner 1.ct. Sworn to before me this MARIOi~' ~.~REUgNI NOTARY PUULIC, ~ete of NaW ¥Of~ No. 52.323312 (Signture of applicant) STATE, OF iN~W YORK, )S.S COUNTY OF ............. ) ............. ~'.~. r~ .... ~.~. ~.~.~fi~ being duly sworn, ~depose,s and says that he is the appli- (Name ,of in,dividu, al signing applicati~on) cant above named. He (Contractor, agent, c~p.~ate officer, etc.) of said owner ~er ,owners, and is drily authorized to pe~rm or have pezSermed the said w~k and to make and file this application; that all statements contained in th is application a~e true to the bes~ of his knowledge and belief; and that the ~v, erk will be peffo~med in the mann er set ~orth~ in the application filed therewith.