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Home My WebLink About3680-zFORM NO~ 4 TOWN OF SOUTHOLI BUILDING DEPARTMENT TOWN CLERK'S OFFIC'E SOUTHOLD, N. Y. BERTIFIP, ATE OF OBOU PANP-Y TIgrIS CEJtTIPlES that thc building located at . 1~/8.. ~'~¢~8~ .PO~g · ~. ·. Stree~ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... D~i.. ~ ..... , 19.6~ ~ursuant to which Building Permit No. dated ...... D~.. 2~ ..... ,19 6~, was ~ssued, and conforms to alt of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . ~V~e. ~a. I'a~llY. Jwel..~.~g ....... [ .............................. The certificate is issued to ..... ~R~..~e~..,, ..... ~e~ (dwner, lessee or tenant) of the aforesaid building. Suffolk Couniy Department of Health Approval ..... . ~t~.... .................... ..... ~~: (., ~..~M,,.~.~ ...... BuiIding Inspec[or TOWN oF'~OuTHOLD BUILDING D~PARTM/EN' TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT ~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AuTHORizED) 'N? 3680 Z o~..~,...~.~,..: ............. ,~.~.o.~.....~, ,~.9.~...~ hereby nmnted to: " " " Permission is ................. JO=,toat; ...... , ...... ,......,.,....~ .................. to l~u.3~ a.. ,ai:t .. a,~ia.xI;.i. Ot~..oil.. ~.. aais.~...~eJ,~.~.~41; ....................................................... at premises located at~.l,..~..~.~....~.l~t~,a,, k~...~$,~.,..D.~3.t,..~.JLt~I~,.,~J~ ................. .................... ~.a..~l~,~a~..~! ~,, ,..11o~t .............. ~.~ ..................................................... pursuc~n¢ to application dated ....................... '.....~D.~.....L..~*" ~'~ Building Inspector. ~ee $~.*.L'..q .............. ...... , 19~...., and approved by the FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ×am;ned Approved ermit No. Disapproved~ ......... .. " 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 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 beforp issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issueio 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 pU?pose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the ibsuance 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. ..... .................................... (Signc(~re o applicant, or nome, if a corporation) ......... ...... ............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ~ .................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.:..~..~.~..~.~.....~....~/..~...~... Lot No.: ......~/....~-'/ Street and Number ..~..~..~.......~....~..~..:~ .................. ~i'...~....~......~...,...'~...~ ............................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Exist}rig use and occupancy ........................ : ......................................................................................................... b. Intended use and occupancy ....................................................... .......................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair ............... Dz~aR~moval ..... ..V.......:... Demolition .................. Other Work (Describe) ........................................ 4. Eshmated Cost ............................................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... I .................. 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 /6, z Number of Stories ...... ~ ........................................................................................ Dimensions of same structure with alterations or additions: Front ~' ~ / Rear Depth ....~.~/.L..~.[~ ............ Height ....... /.~. ............... Number of Stories ..,./ .......................... 8. Dimensions of entire new construction: Front ~ ~f ' ~ ' ~ Rear Z ~ ' ~" De" Height ....~..~..~ ........ ,~umber of Stories .......... ~ .......................................................................................................... 9. Size of lot: Front ....... Z .................. R r .................................... Depth ....... ~.~. ................ 10. Date of Purchase .......... : ............................................. Name of Former Owner 1 1. Zone or use district in which premises are situated .....~..~ ................................................................................ 12. Does proposed construction violate any z~ning law, ordinance or regulation? ....... ~.R ............................................... No. ~.~..~.~. ]3. ~omo o* Ownor o* pr, misos .....~.: .......... dress .......... Phono ~*me of Architect ...................................................... Address ............................................ ~hone No ..................... Name of Contractor ~.~.'~.~.~..,..Address ...~.~..'~,.~ Phone No.~.r~Z..~.*rr 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 i.nterior or corner lot. ~ 6 ~R/e ~A ~ Iv' t¥ S S A g STATE OF NEW YORK, , COUNTY OF ....~.]~?..f.¢~.,../1r ........... ~°"~' .,.. Ta4a }' · ............................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 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 me this ..... ~.~.~ ...... day of ~ , 19~.~. .................................... ~ ............................ ........................................... Public~~ ........ County ~ (Signature of applicant) ........