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Home My WebLink About3821-zFORM ~0.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTI'IOLD, N. CERTIFICATE 13F CII~GUPANI~Y No.. Z. 3.341 .. Date ..... Doc.embar...17., .......... 196B. THIS CERTIFIES that the building located at .l?e~on,tc. Bay. ~Bl~I.d ......... Street Map No ............. Block No ............. Lot No..Laurel,. New..York ............. conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ..... ~.p.1;$~1...~., .......... 196B. pursuant to which Building Permit No. 3821. Z. dated .... .A.p.r.i..1...$, .......... 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 . p.~.i..v.a.t..e..o.D.e.. ~ia.tB$~y...d.u.e. ~13.g.w.&~;h..ga~.atJ.~..(acc.e.~$Qry. ~u;L%d;[nq) The certificate is issued t,o ...J.a.m.e...s..~I. :..M..%lr..r..ay. ...................................... (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval ......................................... ....... Building Inspector 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? 3821 Z Permission is hereby granted to: ...................... ~,~.~re~, .....~,~, ................................................ ,..,,.. ...... ; ................. , ............. .............. pursuan¢ to oppligo~ion dated ............................. ~i33t'.~, ...... ,i~ ......... ,. 19;~:., and, approved by the Buildin.cl Inspector. - ' r ~ Fee $..~.~. ............ ...~., - · ~ui!d~ng Inspect6~ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ... ~..~... .............. , 19 Application No. Approved ......~. ..................... : ........... , 19.:..~.... Permit No..~.~,2................1 ~' Disapproved a/c ..... ~,Z~..:.~.~_-Dz:~4,~__ (Building InspTfor) APPLICATION FOR BUILDING PERMIT Date ........ ~./..~ ........................................ , 19..~ .~... 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, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drown on the diagram which is port of this appJication. 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 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 Regu at ons 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, ordinates, building code, housing code, and regulations. ................................ /'/y. ' (Signature of apl:;licant, or name, if a corporation) ........ .......... ' ................ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ..... ..~.....: .~'..~..~,,,~¢....,..' ...... ~..~C.. ........................................... If applicant is a corporate, signature of duly author zed officer. ~' (Name and title of corporate officer) Location of land on which proposed work will be done. Mop No.: .......... .~ ................ .~.,' ......... Lot No.: ........................ treat an Number .~~..../~'~.. ........... ~::.~..-..:: .............. ~......:~,'..~..,'.~ ............ ~ Municipa~i~ , ..... .................................... 3. Nature of work (check which applicable): New Building .................. Addition ....../¢~.........,. Altera,tJon .................. Repair .............../."'~J~tem°val ,~ ............. Demolition ............. ..~,~Other Work (Describe) 4. Est mated Cost ~: ...~....~...~...~.: ~ ~ .Fee ~'~.,..~.. ,..~?. .......................................................... (to 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 ..........~........~ ......... /,~......~....~..~.../4~. ............................................................................ 6. tf business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ / · . ~. ~ / II 7. D,mensic2ns of ex,sting structures, if any: Front ......... ~..~.. ............. Rear ....... ~....~...-.....~'. ......... Depth ...~....~........~.... Height~2.~......~/~..~.?..~. Number of Stories ..... ................................................................................ / ' -- ,~ ,//~ .,, ~ '-;-;";-:';.')'"":;"~i D~menslons of same structure with alterations or additions. Front ....... ,,2,.,'~.. ..................... Rear .,..~.. ..................... Depth ..~.(.~2...2..0. ............ Height ...e~..~...~.,.~j. ............ Number of Stories ....~ ........................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ............................................................................ i .................... ~-," ~ P --! ~ )~' ~f~ ;.-0 ~ ................... 9. Size of lot: Front ..~.~..~ .............. Rear ..... ¢~...~.. ....................... Depth .......~.. ...................... 10. Date of Purchase ........................................................ Name of Former Owner ..c ..................................................... 11. Zone or use d str ct n wh ch prem ses ares tuated ..... /..~.~.'.-.-~.~...~....~.....N-d......~..~.~...,,~. ............................................. 12. Does proposed cunstruction violate any zoniru~ Iaw, ordinance or regulation? ..... Z',~....~.. ........................................... Name of Arch tect .............. ¥.Address Ph · ' ..... ! ............................. ,,. ....................................................... one No ........ ~..~...,~. Name of Contra;~~.y.~.~:~..Address ...~~ .......... Phone No~.,~..~..' ...... ..~I.....~ 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. ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (Contractor, ¢zgent, 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 ali statements cont,ained in this app!ication 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 to before me this No ay Publiq&.~.,~...~~ounty ~~ture of app[icant) NOTARY pUDilC, St~e o~ New yotL