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Home My WebLink About3452-zFORM NO. 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E:ERTIFIE:ATE DF Br-:BUPANr. Y No. ~ .2.~]0.~... Date ............. Jl,UglZ~:~. .~1.?.., 196~.. THIS CERTIFIES that the building located at ~]~. [~i~l. 0~e~k ~ ....... Street Map No...~... Block No .... ~ ..... Lot No. ~... ~o~]~t,. ~,~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~t. ~ - ~. , 19 67' ~ursuant to which Building Permit No...31!~. Z dated ........ '&~i~ ' ' ~6 ' "19 6~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .PI'iVat~..o~e. $~i3~: .~W~.~t~g ...................................... The certificate is issued to ~a~'~ .~e~. J~ ....... ~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval..~]e~t~ ............................ FOEM NO. 3 TOWN OF $OUTHOLD BUILDING DEPARTMI~NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3 52 Z Permission is hereby granted to: .... ~'~eat~.~ ...................................................... Building Inspector. .Fee $..;..~ ............. ; .... at premises located at pursuon¢ to application dated ........................ ~.~.~-..~...~ ............. , 191~'.,...; 6nd approved by the FOEM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit ................................. Approved. ....................................... , Disapproved a/c ...~~~~ Application No...'~.~...~....~...~... ...... APPLICATION FOR BUILDING PER.MIT ote ...................... , INSTRUCTIONS o. 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 propertymust be 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 will issue a Building Permit to the applicant. Such permit Shall be kept on the premises available for inspecti0.n t~h?gugh.qu.t, 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 issuance' of o 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 oil applicable laws, ordi,qc/}pces, building code and . .......... (Signature of applicant, or name, if a corporation) ............................... State whether.~nt is owner, 'lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................. ..................................................................................................... ......................... Name of owner of premises '''~' X .~.J~ ~.. (-~..~. ~ .~ .~l,~-. ~ ~, If applicant is a corporate, signature of duly authorized 6~ffiqer. (Name and title of corporate officer) I. Location of land on which proposed work will be done-~,Ma, p No: ................. ~. ............. .. ........... Lot No: .................... Street and Number ..~f~.L..~..~...~.....~....~.....~..~...~..~.~..~..~...i~.~~...~....~.~)~.~L'...~: ............................... ' Municipality ~ 2. State existing use and occupancy o~mises and in, tended use and occupancy of proposed construction: a. Existing use and occupancy ......... .~.~..~...:~...(.~.~....~.~ ........................................................ i ........... : ..... b. Intended use end occupancy .................................................................................... ~ ............................................ 3. Nature of work (check which applicable): New Building .................. Addition ...; .............. Alteration .................. Repair ............. .~. Removal .................... Demolition ................ ....z~ther Work (Describe) ...................................... 4. Estimated Cost ...... .~.f.~Z~...~:l~::~ ........................... 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 ~ure 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 a[teration, s or additions: Front ...... ,,,~ ..~ ............... Rear ...... .~..1~,~ ............... ............................. /~' Depth ~.~o~ . Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....,'~...,.C~.. .............. Rear ........~.....~.. ............. Depth Height ......... /..,~ .............. Number of Stories ........ .~ .................. O ' 9. Size of lot: Front ....... ...~.. ................ Rear .....¢~. ................ Depth ...~:~../']~-~..,~.......~_., ,-- 10. Date of Purchase ........................................................ Name of Former Owner ..!~.,.....~..~..t?r...l~.,~..~...~z.~.. ..... 11. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violo~te any zoning law, ordinance or regulation? ........ ..I~../,D ..................................... Name of Owner of premises .~.'.'''~-' TM k~...~....~O .~l~tress .m~t~.~...~.,,...Lr~...· Phone No~.~.~'...~..~. ~..;:~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contract~~......C~..'..°..~,O..Q:l .~... ........ Address .1~_~.':j~..~.,.1~.¢~¢~.; ........... Phone No.~./~..l~..~..!0~ 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ,,YOP~ /~ / ¢ c COUNTY OF~~'~' ....... / °'~' ~r~_~,c~.' '~// '~ ...... ~~ .................... being dulysworn, deposes and says that he is the applicant ..£ ........... ii~'~'~'e of individual signi,ng application) .............. above named. He is the ....~-~f.~ ........................................................................................................................ (Contractor, agent, corporate officer, etc.) of sold 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.~ Ilin Jhe application filed ther~with.~t, --7 ~ ~ /~ /~ ~/~ ~/] N°t a rY ' pUblic' '" ~~~ll~ '~ot~ ' ' ' ' ~: "~'~~[ " ........... : ..........................