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Home My WebLink About3704-zFORM 1~O. 4 TOWN OF SOUTHOLD BUILDING DEPAETMENT TOWN CLEI~K'S OFFICE SOUTHOLD. N. Y. I:;EI~TIFIr:.ATE OF I:ll:II~UI::ANI::IY No. Z. apda .... Da~e .......... J. al~,.- '16 ........... , 19.68 THIS CE!~TIFIES that the building located at ~igi~by' .il(i-~.f~::tI1. 'R~t ...... Street Map N~.att/. .... ....... l~a I'k. t~Ik No. · · 'XX ....... Lot No. ia,b. ~.&~ ..... i4at~cit~ck.{ .. ' I~",Y,'" · conforms substantially to the Applicati. on for Building Permit heretoiore filed in this office dated ........ i~IOV., ..... 9 ....... 19~7.. pu.rsuant to which Building Permit No..3~01t~2~.. dated ........ N(>~'~ .... ~ ....... 1~,~.., was issued, and conforms to all of the require- ments .of the applicable provisi.ons of the law. The .occupancy f~or which this certificate is issued is .... ~tu,~ine.~ a. b~ai3,di~g · ,- .b~a~.-&. mo%.r.o · sto~agt+ .&..1,ep~ir.$. e.l}o · · · The certificate is issued to . ~,l,LoyO..D;L(~ka~l~ao~l ........... O~Ill~ ................... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval ....... .I~I~ ............................. TOWN OF'SOuTHOLD BUILDING, DEPARTMENT TOWN CLERK'S OFFICE sOUTHOLD; N. Y. '/,BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES .UNTIL FULL COMPLETION OF THE WORKAUTHORIZED) bi? .~ ,3704 ,, Z ,Dote'.,~,...:.,.;,.,.: ............ ~a~t~...$..., ~9.6~.., , ~ ~ , Permission is h~roby Oronted to: .... ~.~,~ .... ...... ~o' ~..m..~*~.~a.~a.,~,..~.~.:~.~..~l~ .................................. at premises I~ated at. ....... ~.: ............................. : ......... ~- -.-- - ---- ~.=~:~i.. =~......~ ..................................................................... pursuan¢ to application df~ted ...................... ~t~;.,.....$ ........ , 19..~/..,, and approved by the Building Inspector. FO~M NO, ! ?O%VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned ..... ............. .,9...(.?.. " lg...::... Perm,t No. 3. 2. Q. 7 & Approved ........................................ , ....... Application No.....-~....?...~..~.. ......... Disapproved a/c~~.,.,':..~~.. ....... ,,~__ -. --- .................. ................................. APPLICATION FOR'\ BUILDING PERMIT ,\ Date ........................... ,~,J..~...~..e,.~,.~..~.~...,..9......, 19...0.~. ..... INSTRU~TIbNS a. This application must be completely filled in by typewriter or ,n mk 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 I~g 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 Wi}~ issue a Building Permit to the applicant. Such permit shall be kept 6n the premises available for inspection throughout the ~rogress of the work. e. No building' sholt be occupied or used in whole or i,n part for ar~y purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building De. bartment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Su~ffolk County, New York, and other applicable Laws Ordinances or Regulations, for the construction of buildings, additiops or plterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable I~ws, ordinances, building code, housing code, and regulations. ! ',, D.o...~.~I~s ]~e,.b.e & Son I (Signature of appJicant, or name, if a corporation) / ~ ~a~.n ~oa~ Cutcho~.~ \ (Address of applicant) State whether applicant is owner, lessee agent, architect, engineer, general contractor, electrician, plumber or builder. contractor ." ............................................................................. ?,:.....~ ................ ~-~ ........................................................................................ Name of owner of premises ...JJ,..L]~r~..~l,~ke$t~on....,....,~. ........................................................................................ · ' e' f;cer\ If applicant is a corporate, signature of au,/y aufh~r~z a o (Name and title of corporate o icer) ]. Location of land on which proposed 'work ~,ill be dsne. ]~ ap No.: ....~l~.l;..,~.a~'~,..~.~g:~., Lot No.: ........................ Street and Number ...~Jl~t~..~Jo~.d..~r~.,.f~Sh~'..~,o~l .......... ~.~i,~.~ .......................................................... / I \ Municipality 2. State existing use and occupancy of premises and/intende, use and occupancy of proposed construction: ,/ a. Existing use and occupancy ..... bu~:Lness..~t~;l~i~§s .................................................................................. b. intended use and occupancy ....... ..,i,-~tl~ll~..W,~L~..~..,~,~Cttl.t~io~ .................................................................... Nature of work (check which applicable): New Building .................. Addition ....~,~1~. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost '"'6'jOO~",~ ....................................... Fee .....i .................. 5. II: dwelling, number of dwelling units '~ltl~J~ii ................. 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 ...]~'.~fj~.jj~ ...... 7. Dimensions of existing structures, if any: Front ...........~ ............ Rear ........... ..~; ................ Depth ~i/..&l,2 ...... Height ........................ Number of Stories ........ ~r[~ .................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... .~._..~ .............. : ..... Rear ...~.~)~ ................ Depth ....~[I. ............... Height .................... Number of Stories ....... ~..,. ..................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ....................................................... ~Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated '"~]~#'"'~'S~lC:~'t, .................. ................................................ 12. Does proposed construction violate any zoning law, ordictance or regulation? ...... I~ ................................................. 13. Name of Owner of premises .~.~...:~]j~..D~[ili.~jljil~dl~ess ..... }~l:~,'~.t,~t~]~ ................. Phone No ..................... Name of Architect .............................................. i ....... Address ............................................ Phone No ..................... Name of Contractor ~).~...]~.fj~.~..~..[~. ...................... Ad. dress "'(~i:i'~'~i~' ................... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing ~r proposed, and indicate all set-back dimensions from property lines. Give street' and block number or desc/Ciption according to deed, and show street names and indicate whether interior corner lot. , STATE OF NEW YORK, 1. S S COUNTY OF ..~1~,,!~O,]:~, ............J' ' ' .................. ;;'. .......... ;".'";:":']~O.~'t~il'"]~e~]D~'.'f;'; ................. being duly sworn, deposes and says that he is the applicant abow~ named. He is the ............. ' . ............. ~ ............. . ....................................................................................... 00~0,~ ~ " (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or Have performed the sa~d work and to make and file this application; that all statements contained in this 6pplication are true to the best of his knowledge and belief; and that 1he work will be performed in the mannbr set forth¢in the appl cation f led therewith. Sworn to before me this , ,~ , ~ ................ ~..~o~ of ...... ,.~b,~ ............ ~,..~.~4 ~ ~ . - . . Notary PuN,c, ~..~] ............................... ?..~. ~euntv ";'~-' (S,gnature of apphcant) ~ /~ ,' ~ NOTAR~ pU~I~-Ic State of h~,., '~k ¢' ~o 57.3233~20 Stl[,o]K Co~