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Home My WebLink About3674-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. r. ERTIFII'I. AT£ OF Or.r. LIPANI~.Y No. ~ .3012 .... Date ............ ~b-- .29 .... , 19~. THIS CERTIFIES that the building located at Ilool'~l. I,~®. ]g~tl~ ....... Street Map~o~.%®l~ 8ho~ , .......... ~oc~ No ............. Lot No. 92 ....... G~n~t. ~.~. ..... conforms substantially to the Application for Building Permit heretofore filed ~ tMs office dated ......... ~.t... 1.8..., 19 .~. D~suant to which Building Pe~[t No..J$~. Z dated .......... ~t ..... ~ .... ,19 ~., was issued, and confoms to ~ of the ~equire- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .~l~a~e. o~e. f~ily. ~e~g ....................................... The certificate is issued to ~*~.4. P~2~. A .~ifa ............ ~a ........... (owner, lessee or tenant) of the aforesaid buildMg. Suffolk County Department of He~ Approv~ . .De~ .1~7.. by.~...~llta ...... FOlt~ NO. 2 ~ TOWN O~ $OUTHOLD i BUILDING DEpARTMEN~ TOWN CLERK'S OFFICE! $OUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMI: ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 367t Z D~*o .......... ........ i.....~.~..~.....~?......, I~.....6.? Permission is hereby grant_ed to: L ~..*....~..~,.~......~........~..~ ~. .................. :.....~~.,..I~,X~; ................... ~ld near one f~tlY d~ll...~.. at premises located at ........ .~.l~.~...~u.g~.....~,tg~F~..~J~3.Z'a, t,..~t~ti~ ......................................... ................................ ...~,.~....~. ,~.~...~.~.~.....~e.~r.~..,, ............................................... pursuant to application dated ................................... ~.J/.~ ....... ,1~......, 19../~.., and approved by the Building Inspector. .Fee $~....; .................... Building Inspecfor ~L FOI~I~I I~0. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW, C~-ERK'S OmCEi SOUT.O'O, N. Y. Examined ..... [~¢.t.~M~:.....Z...~,...,., 19....~., Approved .................. ~.: ................... , 39....~'... Permit No ...... D~sopproved ~/c ................................ ~ ................... ~ ..................... ~,~ ........................................................... ............. :. Application No...,=~.~:..~.,.,~.. ........ API~LICATION FOR BUILDING ~ERMIT ..i ........ ............... , ............ 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 property must be drawn bn the diagram which is part of this application. c. The work covered by this application may not be commenced befode issuance 0f Building Permit. d. Upon approval of this application, the Building Inspector will issue, o 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 i~suance ora Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork,r, and other applicable Laws, Ordinances or Regulations, 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, builc~ing code and regulations. · ............................................ ,,~/ (SignatUre of oppllc~antC~r name, if a corporation) , (Address of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........... z. .................................................................... , .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map~lo.: ..~.,..~...~....~.. ................... L.of No.: ..Y...~..?. ........... Municipality State existing use and occupancy of premises and intended use an~t occupancy of proposed construction: o. Existing use ond occupancy ......... ~ ....................................~ .......................................................................... 3. Nature of work (check which applicable): New Building .....~... .......... Addition .................. Alteration .................. · ~Repair . Removal . Demo t on ................ Other Work (Describe) ............ · ~,.~ Estimated Cost .......... ~'..~...~.. ....................................... Fee .......................................................................................... · (to be paid on filing this application) &./ If dwelling, number of dwelling units .../. ........................ Number of dwelling units on each floor ............................ ~t, If garage, number of cars ..J. ........................................................................................................................................ · 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 ......... ~.~...: .................. Rear....~...(?..: ............. Depth ......~..~....~ .......... Height ..../....~...r. ....... Number of Stories ...... ~...,~'.Z~ ................................................................................................... 0. Size of lot: Front ...... ./../.~. ................ Rear ........... ~../..~.. .................. Depth ........ ./.~.~ ................ 10. Dote of Purchase ...... .?..':../.Zz:../~..Z ............................. Nome of Former Owner .~.:...O~...~i:~,,,~.~.j~..(~:~...' 1 1. Zone or use district in which premises are situated ...~..-z..,e.~./~....¢r~..~.. ................................................................... 12. Does proposed construction violate any zonin,~low, ordinance or regulation? ....... ..~..~.,.~.'...-~.. ..................................... t3. Name of Owner of premises ./Z'..~..~.,~/'l~.~,o...~,~JzJ-~-~fI.Address ..... ..,~..~. ......./,Z..',~.... ....... Phone Nome of Architect ..... r~ ......................... ~ .................. Address ............................................ Phone No--~z .~. Name of Contractor .~: ............ Address ................ Phone N . ..~. ....... ~ ~.. ..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing' or proposed, and indicate all set-back dimensions from number or description according to deed, and show street names and indicate property lines. Give street and block whether i,nterior or corner lot. STATE OF NEW' ~O.l~l~f'. I~.~ i, ¢ ¢ COUNTY OF ...~/~.~{...~........f-':'" ............................... '...~~?....~:~ ........ being duly sworn, deposes and says that he is the applicant (Name of in ii, dual signing a[~lication~ abow~ named. He is the ..................... .~...~...'~..~ .............................................................................................. (Controctor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make a.nd 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,,,~ -- ,,~ Z") zme this _ ~z~---._-/ .............. /...7.... day of ........ MAR ON A. REGENT l/ · NOTARY pUBLiC, State of New ¥or~ V I'1o 52-3~33120 Sui(olk Coul]tV ,'[ei'm Expires M. arch 30, 19~.'~