HomeMy WebLinkAbout4154-zFO~M ~0.4
TOWN OF SOUTHOLD
I~UILDING DEPARTMEN~
'I'OWi~ CLERK'S OFFICE
SOUTHOLD, N.
CEETIFICATE 13F EI[~BUpANBY
No.Z .3348 ..... Date ........ December.. 17, ....... 1968.
THIS CERTIFIES that the building located at Sicjs~a~.l%oad ............... Street
Map No. httit~Ck Block No ............. Lot No. 40...Matt~t~C~, N~..YO~ .....
Pa~k
conforms substantially to the Applicati. on for Building P~rmit heretofore filcd in this office
dated ...... D~I.. &2.,.., 1958. pursuant to whi~ Building Permit No. ~..~.
dated ...... D. ee~.. i2,.., 19.68, was issued, and conforms to all of the require-
ments .of the applicable provisions of the law. The occupancy ~or which this certificate is
issued is ~=tvate..one. f~tly. ~elltng. ~tth .g~age. (access~y.
The certificate is issued %o ... ~r~es .Bali ........................................
(owner, lessee or tenant)
of the aforesaid building.
.Suffolk County Department of Health AppFoval ....... ~..,.....~.~{( ......................
FORM NO. 3
TOWN OF $OUTHoLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFIGE
$OUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISEs UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 4;154 Z D~e ............ ~ee ~2
Permission is hereby granted to:
..... · .~.... ~...~....~el
F~tt~tuek
to .~.~w...p~t~..~ ..............................................................................................
at premises located at ............ ~..~.....~.~[~k..~a~..~ ..................................
..................................................... ~.....~..~ ......... ~t~ ........
............................................................................................................................
pursuan¢ to application dated ................. ~e ]~ ]~ ~ , and approved by the
Building Inspector.
Fee $
NO. !
Examined ....~:.~..: ......................... , 19.
TOWN OF SOUTHOLD
BUILDING DEPARTMEN'I~
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Application No ............................
Approved ........................................ , Permit No .......
D~sapproved a/c ..........: .......... :.....: ............ ;;3~- ............. 4=.~....~.: .........
........ (Building Inspector) ...........
APPLICATION FOR BUILDING PERMIT
Date ............................................................ , t 9 ............
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 buildings on premises, rebti.onship to adjoining premises or public streets or
areas, and giving a detailed description of layout of property must be drawn on the diagram 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. Such permit
sha be kept on the prem ses 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
Building Zone Ordinance of the Town of Southold, Suffolk County, New Y:ork, and other applicable Laws, Ordinances or
Regu at OhS, for the construction of buildings, additions or alterations, or (or removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code .and regulations.
(Signature of applicant, or name, if a corporation)
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, genera! contractor, electrician, plumber or builder.
.......................................... ~i~ .~:. !.~. Y~ .17./.~ .k......C...O..fJ..~...~./~.f,.'.~..~..L(.. ...............................................................................
Name of owner of premises ...¢.'~l.~.~.~.l'~..C...C...%. ............ ~.iLl.~ ......................................................................................................
If applicant is a corporate, signature o.f duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No.' /~.!/~.~.ZT..u-.C.~ ....... /)h~.~._.. Lot No.: ....~.~ ...............
Street and Number ../.~..4..~ ......~.L~.f...B.~..~:..?~.~ ................................... /yJ.~...7~L/..~.~..~ .............................................
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ....................~..y.~..~../x./v.)..!:L.l~.. ...........................................................................
b. Intended use and occupancy .................. ~...~.~...A...J~....~.~.. ...................................................................................
3. Nature of work (check which applicable): New Building .................. Addition............_....~ Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost .............. ..~>./,..~.7_~.~ ............................. Fee ..........................................................................................
(to be paid on filing this application}
5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor .............. -~z.:: ...........
If garage, number of cars ............. /'~ff...~. ....................................................................................................................
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 alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ....... ~,.O...~ ................. Rear .....,,~..~....~ ............ Depth ...,,r~.~...~ ..........
Height ...../.,~.~ ....... Number of Stories ................... :.:::.::..-';....-r.;:;7..-;...: ........................................................................
9. Size of lot: Front ....... .~T..0..'. .............. Rear ......... .~'.~ ...................... Depth ..... /..~.~. ...................
10. Date of Purchase ........................................................ Nome of Former Owner ........................................................
1 1. Zone or use district in which premises are situated .....................................................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................
13. Name of Owner of premises ~..~J!Lc..C.~. ....... j~.&l~ .......... Address /.~/.~....~.I.~.S..~..~.~;:I~.~ ......... Phone No.~.?.~..z.~'J..~..~..
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor /'J~.~.~'Z.~.c.'./.~.....,/~.~.L4..~l/~!.~.....c..~.~..P..Address /:/, k S --
· .~/..: ........... )~.0.....J~.uT~../.~.~.".C Phone No.~.~.:..ff.f.~...~
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 N E~V YI;~I~K~ / ~. ¢ e
.....................r/~/_ ~,_ ..~...?.~....~...~...... .......................... being duly sworn, deposes and says that he is the applicant
(Nome of individuq~n~Jication) . ~ .
obow~ named. He is the ...~...,~_~.~~ .................................... ; .....................
~ ~/ ~ (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 Jn the manner set forth in the application filed therewith.
Sworn to ~re me this _~ ~ _ ~
Qualified ~n Suf[olk Cn,.~nty
Term Expires March ~0, :~.~