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Home My WebLink About4304-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk% Office $outhold, N. Yo Certi icnfe Occupnncy No. ~..366~ ..... Date ....NoVember .... 26., ........ , 1969.. THIS CERTIFIES that the building located at oorne'~ -of- .l~$r~ewood. R. oad Street & So~hern C~ose Road Map No ............. Block No ........... Lot No. Cu~hocJue~- t~. Yo~k ......... conforms s~?niia~to the Application for Building Permit heretofore filed in this office .~_, c~ated ........ ~,Is.y .~; ...... , 19..69 pursuant to which Building Permit No. 4304. Z.. dated ........ ~la.~ .23.° ....... , 19.69., 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 ......... pr. ivate .one..family. ~e~ling ............................... The certificate is issued to . A, t4~..V~nde~eek ..................................... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of l~Iealth Approval .................................... 'Building' Inspector House % 845 Pinewood Road % 630 southern cross Road FOEI~ NO. ~ TOWl'4 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? 430] Z Permission is hereby granted to: .... ................ J~..t,t~-:[.t,,t~ek .......................................... to ......... ~t~l~....~ ..~.~,.~.~t~a ..mL~...~t~r~ -.~.e11~ ............................................. ......................... ;~;t"-' ............ :~ ............................ ' ........................ .......................................................... at premises located at ...~...~..~...:..~..~,..{~/)l;t,t,h~J~L.~,~JjJ/IB...JJl3a~TM ...................................... pursuant to application dated ............................ ~..~ ......... ~..........., 19..~., and approved by the Building Inspector. Fee $ ..~.~ .~. ............ Building Inspector Approved ........................................ , 19 ........ Permit No....~ .................... Disapproved a/c .............................................................................................. t ui lng Inspector) / APPLICATION FOR BUILDING PERMIT ,'- INSTRUCTIONS a. This ~pplicotion 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 propertymust 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 in part for any purpose whatever until a Certificate of Oecupancy 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 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 and regulations. ..... ......... ...... ......... ....... ~/-r"z ..... '(A-""'~re&";i'~'~ii~;i ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrici0n, plumber or builder. Nome of owner of premises .....~..,...m ....... ~.~....~.~...~..~....~ ......................................... i ................................ If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. M. ap No: ............................................ Lot No: .................... ,~,'~'~--~ ~ ' C.' , Street and ~"umber ............................... ,~,,,~.......~.....S,K..~..C,/.~/.,~E.~..~--./I,,/...,,...',~.,~,,C..,,~L,1. ,,~/ ........... ~ ~ ~' ~~ ....... ~Zh~-~--~ Municipality State existi~ use and ~c~ancy of premiss and in~end~ use and ~cu~ncy of p~ construct on' a ~ st n- use and ~cu~anc- ~ /~ ~r~ b. Intended use and ~cupancy ............... ~.~ .................. ' ........................ 3. Nature of work (check which applicable): New Building .................. Addition..................~ Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ,.~,,~ 0 .'~. (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 ........................................................................................................................................... 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 ....r~..~.. ............. Depth ....~....O.. ................. Height ............................ Number of Stories ............................................................................................................... Dimensions of same structure with alterations or additions: Front ~ ~ · ............................... Rear ..... .~..~. .................... Depth a~.....O....Q..'~.......~...~...~ Height .............................. Number of Stories ..... ~'... .............................. 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ........ . ........................... 12. Does proposed construction violgte any zon ng aw, ordnance or reau arian? ...................................................... 13. Name of Owner of premiSes ~/...~..'...~/.~/~.~.~v~.~..(..~'.Address ....~....~.../.~....~...."~Q~.~.~.'. .......... Phone No .................... Name of Architect ......... , ........................................... Address ............................................ Phone No ..................... Name of Contractor,~.~l~..~.. ~fi$/~-----~Address G~.....~..,~.~...G...'~... PhoneNo.'~..?/..-C....c~/..]..O.[ 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW' ','GRK, ). ,. ,. COUNTY OF ...... ~, ........................ ~ ~'~' ,e - .............. ~[ ............... :,, .................. : ..... :..,?....L.: ....... b~'ng duly sworn, de~ses and ~ays that he is the opp cant (Name of individual 'signing appdcat~nl above ~med. He is the ........ ......... ~~.~ .................. (Contractor, agent, corporate officer, etc.) of said owner or ownem, and is duly authorized to perform or have peOformed the said .work end to make and file this application; that all statements contained in this application ore true to the ~st of his knowledge and belief; and that the work will be performed in the m~ner Set fo~h in the application filed therewith. Sworn to before me this ' .... .............. .......... .................. / .- /* . ...... .................. ~ ~ARY PUBLIC, State of New ~. .o. 52-8125850, Surf,'" Term Expires March 3 . ·