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Home My WebLink About3837-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy No. Z3960 ...... Date ............ Sept .... 2~ ..... , 19~0, THIS CERTIFIES that the building located at . .B/S. Midale .Road. (C1%27) Street Map No. ~ .......... Block No...~ ...... Lot No. ~.. Pecoale. ·. ~.,.~, ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ April. "9'" ' 19.~0~ pursuant to which Building Permit dated ........... April. · 9 · ', 196~ ', was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . P~ivate .one..family. ~welltng ....................................... ~e certificate is issued to .. He~m~..Haa~ ..... ~n~ .............................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .P~t~lO ........................... ~FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (~HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3837 Z Permission is ~ereby granted to: ....... ~..~.a.a ............................................. to tat~.4...n~...tava..a~T...~e.~e.~.~...g,l,dg~ ..~,~.~.a ~= ..~..~ 1 ................................... pursuant' to application d6ted ............................... A~.~ ....... ~. ...... , 19.~.., and approved by the Building 'Inspector. ~ FO~ ~0.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW'N CLERK'S OFFICE SOUTHOLD, N. Y. OI~I~TilZIOATI~ OP O00UI~ANOY No. ~ .z3098 Date ............... ~yll~ .... ~ ........ 1968. THIS CERTIFIES that the building located at .~I/.8...Itii.~q~a .al:la~. ,(R~27)Street Map No. ~ ........ Block No.~ ........ Lot No~ ..... ~O~t~. · .~, .......... conforms substantially to the Application for Building 'Permit hereto~ore filed in this office aatea ............ A~i~... 9" 1968' pursuant to which Building Permit No.. dated ............. ~D~t~..~.., 19.68, was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. ~he .occupancy f.or which this certificate is issuea is ...lwo. s.~e~y .aa.~age. & .Sho~' ~la~g .................................. The certificate is issued t,o .~e~. ~ .............. ~e~ ....................... . (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval .... ~gR.~ ............................... "~ q ~ '~ B'" ~i~i~k' i~e~;~;i' ..... ~ ...... Examined BUILDING DEPARTMENT ~ 7 y~ ~ TOWN CLERK'S OFFICE~ · ,~'~, ~'~-.~ ~,'~C~ ~H~,N. Y. ~ ~ ~ ~'~"'~ ' Application No....,~......~.....'~..,.Z ..... ~ APPLICATION FOR BUILDING PERMIT Anril c) 19..6...8. ...... Date ............................... ~. .......................... , 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 a detailed description of layout of proparty must be drawn on the diagram which is port of ;~S 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 in part 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 Laws, 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, housing code, and regulations. (Signature of applicant, or name, if a corporation) North Road S out old (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................... .............................................................................................. Nome of owner of premises .,,~.e...~...~...~.....~.~..~..s. ........................................................................................................................ ~ If applicant is a corporate, signature of duly authorized officer. ~ ~x.C/~ (Name and title of co~orate officer) ~1. L~ation of land on which pmp~ed work will ~ dane. Map No.: ........... .~ ..................... Lot No.: .~ ................ ' ~~Number .l/a....~e..~..(C~23.....~ec.~c ....... ~.~. .......... : ........ ~ ................................. 2. State exi~i.ng use and ~cu~ncy of premises and intended use and ~cu~ncy of pr~ constmcti~: a. ~isting ~e and ~cupancy ..... ~ .......................................................................................................... Same w:~th ~ ~.9.~.se & Acc Bu d & S e b. Intended use and occupancy ......................... ~....g ......................... Z ....... lL~,...:LT~g...(gl~.~,~. .......... .~.9.r.~.g 3. Nature of work (check which applicable): New Building ~ ........ Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ~..0..0.....+.. ............................................ Fee ...1...0.~.0...0. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... ~e ............. Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................. 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 a.lterations or additions: Front .., .........................;. ..... Rear~ ....... ~ ................... Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .....2..~.. ........................... R"r .,~,,~,.~ ................ Depth ...~......~.....~.... Height .................... Number of Stories ..t~...O. ............................................................................................................. 9. Size of lot: Front ...... '].0J0 ............... Rear ......... .1.00 .................... Depth ..... .~.C~)....+. ............... 10. Date of Purchase ......... .~.,~..6.~. ..................................... Name of Former Owner z.~...C.a:.~..e. .......................................... 11. Zone or use district in which premises are situated ...."...~.~......~...~..~..~. ............................................................................ 12. Does proposed conStruCtion violate any zoning law, ordinance or regulation? ............... ..~..O.. ....................................... 13. Name of Owner of premises ..~..,[[a,s~ .................... Address ......~.g.~.~..~..o.~,.~. .................... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........ .~..~..~...e. ................................... Address ............................................ Phone No ..................... 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 NEW' ~'OI]K,.. I ~ ¢ COUNTY OF ..... ~..~....z.g....~.. ........... ~- ~.~. ...................................... .~..~.~,~...~. ................................ being duly sworn, deposes and~says that he is the applicant (Name of individual signing application) above named. He is the ....................... O'~:z~.,~..~...~l~,ez'. .......... . .................................................................................. (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 in the manner set forth in the application filed therewith. Sworn to before me this ~_.~ .................. of ..................... ........... , 7 - ' /, .......... .................... Notary Public, /..~./~_...~Z ....... ~'l'~.-. County (Signature of applicant) ~ARION A. REGE. NT I // NOTARY PUBLIC, State of New Y0r~ /'lo. 52-3233120 Suffolk Country, ~'errn Expires N[arch 30,