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Home My WebLink About3828-zFOI~M ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BE:RTIFIGATI~ DF I:3E:P-UPANP-Y No..~. 3375... Date ........ December...17., ....... 19.68. THIS CERTIFIES that the building located at P~a(]tee..Sho~e~ .Ro~d ..... 'Street Mhp No. Rey(~Oll .... Block No ............. Lot No. 38. · SOta~;hO:[(l~ · New- .¥Or.~ ...... Shores conforms substantially ~o the Applicati,on for Buildlng Permit hereto~oTe filed in this office dated .... April.. 5, .......... 19.68. pursuant to which Building Permit No. 3828 .~.. dated ... April...5, ........... 19. ~6, was issued, and conforms to all of the require- ments .of the applicable provis~ons of the law. The .o,ccupancy ~or which this certificate is issued is ...private. one..famil~ .clwell.ing .wt~h. add. ii;ion ...................... The certificate is issued ~o ....Victor.ia. Pu~es~ .................................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Appr,oval ......... ./.~/.. J. :': . ...................... FORM 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) 3828 Z Permission is hereby granted to: .................. ~..~ ~...~ .e..,...e. .......................... .................... Pa~.e. ct;Lae...~i~or~s ........................ ...................... ~e.~tho.].~ ...................................... to ~t~3~.aa..m/d`1~tJ~mz~.~`~;aka.Alt~.&.t~na~n~e~t~;~g~.~...g ............. at premises located at ..... ;;./t./~.....~,,a~ad.i. se..~heltes..~-~c~l ........................................................... pursuan¢ to application dated ............................... .~'~.1'.....~. ........ , 19.~;~.., and approved by the Building Inspector. Fee $ "~:i,'0~' ............ x TOWN OF SOUTHOLD ~'~ ~ BUILDING DE~P~RTMENT ~' . , / / .~ TOWN CLERK S ~FICE 0~' ~ ~THOLD, N. Y. ~amJned ................... , 19 ........ A~lJ~tion No ............................. ................... ................ , 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 o.f lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed descriphon 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 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 Jn port for any purpose whatever until a Certificate of Occupancy shell 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 Lows, 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, hous~ code, and regulations. Signoture of applicant, or name, if a corporat~pn) (Address of applicant) / ,-y~, ~.~. ...................................... .................................................................................................................................... Name of owner of premises ........................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No.:~..~.y~...q. ~) ............ ..'~'.~..~...~...~...J'.. Lot N~:'..~.....?.. .............. Street and Number C/~.J~./~.~.!..'..3..~.....3.~..~.~...~. ......... ~.~...-. ......... ...-~..?..~.....T'~..~..e..~.~. ........ ~..:..~., .......... Municipality ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.i .~.J....~....C..~....~.. ....... ~.~.~...~ ...................................................................... b. Intended use and occupancy .....U..~.7~..!../~..i...'~...y~......../~.~..¢....~ .......................................................................... 3. Nature of work (check which applicable): New Building Addition ../~,~.fe~.. Alteration .................. Re,ir ~.~.~... Removal .................. Oemoliti~ .................. ~her Work (O~cribe) ........................................ 4. Estimated Cost ............. ~...~..~.~.~..~. ...................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each flor ............................ If garage, number of ~m ............................................................................................................................................. 6. If business, commercial or mixed occupancy, sp~i~ nature and e~ent of each type of use .................. y.., .... 7. Dimensions of existing structures, if any: Front .~~ ...... Rear ...... ~.~..~. Depth ....~:~.~ Height ........................ Number of Stori~ ................. ~ ............................................................................................. ~ Dimensions of same structure with alterations or additions: Front .............................. ~.. Rear .........e .................. Depth ................................ Height ............................ Number of Stories ..~.~.~.~..~.~'~ ~ ~'~/~ ~ ~T 8. ~i~ension~ of enti~e n~ con~t~uctiom ~mnt ....................................Rea~ ............................ ~th ........... ......... ~ ~eight .................... ~u~b~ o~ ~toHes ...................................................................................................................... 9. Size of lot: Front ........~...( .........Rear ...... ~..~ .................. Depth ...... t..~.~..z..~. ' ' __ 10. Date of Purchase ..... ~..~.~.~ ...........................N~e of Former ~ner 11. Zone or use district in which premises are situated .~.....~.~.....~..~..~.~.~....~.~ ...................... 12. Does Proposed construction ~i~t~ any,zoning law, ordinance or regulation? ,. .......... ~. ....................................... 13. Name of ~ner of premises ~{~.~.~A~....~.~.~ddress ~.~.~.~.~.~.....~hono No~Q..~.~ ~ame o{ Archit~t ...................................................... A~mss ............................................ P~n~ ~o ..................... ~me o{ Contractor .................................................... A~ress ............................................ ~n~ ~o ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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. i COUN~ OF ~...~~.$ '~ ~ (Name of individual si~ap~icatio~ above 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 ~ke and file this application; that all statements conta:ined in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application' filed therewith. Swam to befo~ythis ~......~ ~ .......... .... o, ....... : ........ . .......... : ............... Nota~ ub lc, :ZZ~.....~..,,~... Coun~ (Signature o app icant) ~RION A. REGENT// ~OTARY PUBLIC, SlaJe of ~ Yolk 80. 52-3233i20 Suffolk Coun~ ]erm ~pires ~rch ~0,