The URL can be used to link to this page

Home My WebLink About3686-zFORM l~O. 4 TOVTI~ OF SOUTHOLD BUILDING DEPARTMENT TOW~ CLERK'S OFFICE SOUTHOLD. N. Y, CE~TIFIEIATE OF OEI~PANI~Y No. ~...3..0.2.2. .... Date ...... i ApE.~I..4, ............. , THIS CERTIFIES that the building located at N/~. ~eE..A~, ........... Street ~ap ~o.~.. mock No ............. Lot ~o.~....~u~e~a..~..z.....~..~. ...... conforms substantially %o the Applicatf, on for Building Permit hereto~o,re filed in this office dated ...... Apx$l..2~ .......... 19.~ pursuant to which Building Permit No..~. dated ...... ~t,..2~ .......... , 1967" was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .o.ccupancy ~or which this certificate is issued is ....... ~&~.~t~..on.e. f~&ly. ~1~ .... ~ ................................ The certificate is issued ~o .... ~..Ba~el ~&~=~ .¢.~ ....................... (oWner, lessee or tenant) of the afore.said building. Ai , ~ Suffolk County Department of Health Approval ......................................... Building Inspector FOEM NO. 2 TOWN OF $OUTHOLD i BUILDING DEPARTMi:N~' TOWN CLERK'S OFFIC~ SOUTHOLD, N. Y, BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMIS~ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3686 Z Permission is hereby granted to: ................................... ~...A~,~ ............... ~tJae~l~ ........ ~, .......................................................... pursuan¢ to application d?ed ...................... ~ ............ l~....~J~i ......, 19..~i~., and approved by the Building Inspector. tee ~ ........................ Building Inspector FOEM NO, 1 'i'~OWN OF $OUTHOLD TOWN CLERK'S OFFICE SOUTHOLD, N. Y. fixomined ......... ~..~ ........ ~ 19 . Disopproved o/c ........~ ............. ~ ................................................ ......... ............................ ............................... Application No..?.~:..?...~.. ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn Jan the diagram which is part of this application. c. The work covered by this application may not be commenced before issuence of Building Permit. d. Upon approval of this application, the Building Inspector will issu~ o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any PUrpose whatever until a Certificate of Occupancy shall hove been granted by the BuiJding inspector. APPLICATION IS HEREBY MADE to the Building Department for the i~Ssuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New york, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ~-~ ~ H.D. Winters Sou~}~old State whether applicant is owner, lessee, agent, architect, engineer, generql contractor, electrician, plumber or builder. ............................................ z ................................................................................................................. Name of owner of premises ..?~.~.~$~$..:':~$~.~Z~ ................................. : .......................................................................... If mpplicant is a corporate, signature of duly authorized of{icer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .... ~...:~..Z:.~.e..~,...?..~.~...~..... Lot No.: ~ ............... Municipality State existing use and occupancy of premises and intended use an( occupancy of proposed construction: a. Ex~stmg use and occupancy ...D..eJ.].Z.l~ ............................................................................................................. same ~zth ~ at] o ad,tn -c , b. Intended use and occupancy ................................... ~: ....... ~. ......... ~ ............ :.~ ........... 3. Nat of\work (check which applicable): New Building .................. Addition ...~ ........ Alteration ...... :~,','~C .... Repair \ .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ........~../....OZ~....?....~ ............................. Fee .~..,.O.g ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............ .O.~ ......... 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 ...... .L.F..~ ..................... Depth .....~./.?...~.... Height ........................ Number of Stories .... ~e ...................................................................................................... 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 .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ..............]:.~..6..];. .................................. N.ame of Former Owner ...~..];..c];....~..e..¥......~..o.?.~. ........................ 1 1,. Zone or use district in which premises are situated ..!!&!!...~.;J:.~.~ ................................................................................ t2. Does proposed construction violate any zoning law, ordinance or regulation? .,..~O ................................................... 13. Name of Owner of premises ..~?..D..:.!?.~!~.~.z'..?. ............ Address .~..o..~.J!..~.?.?.;~ ........................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...... ..~..8...~..~. .................................... Address ....~9.~..~.h...O..~...~. ..................... 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 Y~RK. COUNTY OF ...... ......................... ]~..D,~r~.i~..;~r~.,~,z~,~ .................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) abow~ named. He is the ...................... .o.~.~..e.~...~.]r..~?...z.. ................................................................................................... (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 lhe best of his knowledge and belief; and that the work will be performed Jn the manner set forth Jn the apl?lication filed therewith. Sworn to before me this . \ ~, · . ~...~. .......day of ....... ~ ..................... , 19..~? /~ ~, ~ ~ ,~ /~ '~ . ~_ ~ ~ . ~ ~ , ~ . .............. ~..f..~...~...~ ..................... Notary Public, [.Y.I~.....~......[~.... County ~ (Signature of applicant) NOTA ~.~33~2 Sufio~ ~ount~ ~