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Home My WebLink About3746-zFORM ~0. 4 TOWN OF SOUTHOLD BUILDING DEPABTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. OEI~TIFIOATI~' OF' O00UPANOY Map No ............. Block No ............. Lot No..3.,..$~tlt;ll~oJ.~,..N.~'~..YOI2~ ...... conforms substantially ~o the Applicati.on for Building Permit heretofo.re filed in this office dated ...... .D.c..c.e. ll~.ex...~$,.., 19.6.:7. pu.rsuant to which Building Permit No. ~.7.4{5..~'. dated ...... .D.~.~..e..m~..e.~....21..9.,.., 19~.7.., was issued, and conforms to all of the require- merits .of the applicable provisions of the law. The .o.ecupancy for which this certificate is The certificate is issued 8o .0'..obiT..& .l~'.r. aLn.ce..$..S..chllt~..~.t; .............................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......................................... Building Inspector FOF.~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) .3746 z D~e ............. ~.~. ...... ~.~. .......... ,~i~ ........ Permission is hereby granted to: ]~eo~evelt ,o ........... ~...~;.~:~.~..~..~...~...~.~.~. ........................................... at premises I~ated at ..... ~.;~...~...~:~...~...~ ............................. Bruil~ting Inspector. Fee $ ' '.' r FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT.OLD, N. Examined ........ ........... Approved ........................................ , 19...~}... Permit No ........................... Disapproved o/c ...:~~. (Building Inspect. r) APPLICATION FOR BUILDING PERMIT Dote ................... ~......~...~ ............ 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 on 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 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 sh~ll be occupied or used in whole ar in part for any purpose whatever until o Certificate of Occupancy si3all 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to compty with all applicable lows, ordinances, bui!~djArg code and/~egulations, :: . .......... ..: .......... .............................. (SFg~a(ure-Sf applicont, or name, if a corporation) ...... ........ (Address of opplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. I{ opplicont is o corpor~to,(Si~n~ture o{ duly ~uthorixod officer. (Nome and title of corporate officer) 1. Location of land on which proposed'work will be done. Map No.: ........................................ Lot No.: ...~'~.. Street and Number -'?~,,~,~4''~ ~ ~ . ~,~,~ .?..4.~,),/').~..Z,..~. ...... ..~..~..~..~..~.. .,~.{.q.~.~i3 ..................................... ................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy b. Intended use and occupancy 0 3. Nature of work (check w~ick~ applicable): New Building .................. Addition .................. Alteration ....... i .......... Repair .................. Removal .................. Demolition .................. et/her Work (Describe) ............................. 4. Est m t "~ 0 c~ ated Cos .........~... .............................................. Fee ........... .,~.. '. ............................................................. (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 exist' g structures, if any' Front .....~.. Rear .........~.....,~.... ........... Depth ..'~TZ) .~... ..... Heght /..~ ' ! Number of Stores .....~?.,.~ . ' Dimensions of same structure with alterations or additions: Front .................................... Rear ................. ........... Depth ................................ Height ............................ Nt~mber of Stories ................................ 8. Dimensionr~ of/lentire new construction: Front ....... /.L.~IM~ ............... Rear ............................ Depth ..... ,~..7~ ..... Height ... L.~...~.... ....... Number~. ,~,^f Stories ......... ~' '"f"(' ~' ~-- ~/''~:"Y;v ....................................................................... ~ ~, ' ----- ~' .".'"'.' ..... 9. Size of lot: ~ront ...... .~/...O..~ ..~..: ..... Rear ...... /....~.... ,..~.-.__ ............. Depth ........ ..~..~...~..~.~'. ........ 10. ~,oa~ ~fr uPsU:Cd~:c~"i~': ~i~r~"~;;'~'~'~'~ ...... Name of ~~....~'.~.~ ....... 11. ' ..... . ................................................ ;- .............................................. 12. Does proposed construction violate an,/zoning [gw,~o?dinance or regulati.on? ....,z) .......................................... , ........... . 13. Name of Owner of prem.s ..~.~.,~'~..¢.~ddress/.~//(.4-.'~.~..~..~.:~.~.,.~ .~...~..,. Phone No.2,.7...~.7. Name of Architect ...................................................... Address ............................................ Phone No .........; ........... Name of Contractor .................................................... Address ............................................ Ph(~he No .......... : ........... PLOT DIAGRAM i 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 ndicate whether interior or corner lot. 7 STATE OF NEW YORK, 1 S ,S COUNTY OF .xr..~ ................. .~.?....~.~ ' ' ................. ~-....~..~...~...:.~..~...~... ............................... beigg duty swor~jdepos~s and says that he is the applicant' ~(N~/me of individual sig~p~li~tion~ // ~,J~ , above n~med. He is the ............ ~.~..~.C.~~ ........ ~ ................................................ ~ ........... ~ (Contra~, 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 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 be~ore me this -- /'I , -) ~ :