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Home My WebLink About3484-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIP. ATE OF E)E:EIUPANEIY No. Z. 2829 ..... Date .............. THIS CERTIFIES that the building located at .~/1~.. 1~1'~. ~ .......... Street Map No. ~ .... BIock No ..... ~ .... Lot No..:ll::~: .. · 0t~le~l~ --~.~/~, ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ]~'.. ~ , 19.6.~. pursuant to which Building Permit No.. dated .......... ~,... 1~ .... , I9.6~, was issued, and conforms to all of the require- rnents of the applicable provisions of the law. The occupancy for which this certificate is issued is .... l[elt~tell~ .lt~- ,l. dia~ · .. (lhu~h. & .&eoe~Sox2r -use~ ............... The certificate is issued to . 0~lent. ~on~e~$~;im'~al. Chu~h ...... 0tmele. ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... .NA~.~. ......................... 1;'Ol~ NO~ ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. BUILDING, PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION' OF. THE WORK AUTHORIZED) N? 3484 z Permission is hereby granted to: : at premises located at ..,....~.~...~.~,..~..~.~ ................................................. ~..,....,. ........................... .... -.: ................... . ........ :.,:.'.,..%~.,~txt~....~,~.~ ........ :.' ........ : ........... '....~: .......... ;:....:, ................. : ......... purlu;a~¢ io opplk:ation;doted .;....,~,?..,;;:.'..'....:...,,.~:......1:~:. ........ ;, 19,.--:.i.., dad appro,¥ed by the Buildiog InspeCtor~ ~ ' ., , ~ -, :,- ,,, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDI~IG PEP, MIT Date ......................................................'~'~/~ /~ ..... , 19.~.~ ...... INSTRUCTIONS a. This applicaiion 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 issuance of Building Permit. d. Upon approval of this application, the Building ~nspector will issue a Building Permit to the applicant. Such perrnit 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 have been granted by the Building Inspector. APPLICATION IS H.EREBY 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 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. ............................ '""1'~'"' '~: ........................ ( 'g o pp' , or name, if ~"~';'r'~o'~;¥i~'~')': ....... .................. ............. ............. State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Name of owner of premises ....~...~t~'~.~..~.~...~~ ....................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wilt be done. Map No.: ........................................Lot No.: ........................ Street and Number ......~..~..~.......~.6'~f ....................................... ~..~... .............................................. Municipality 2. State existing use and occupancy of ,~,.e~-'-~'an~/intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~.~..~'..'.~f...',~ .................................................................................................... b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building ......... ; ........ Addition ......~., .......... Alteration .................. Repair .................. Removal .................. Demolition ....... ........ :.. Other Work (Describe) ........................................ 4. Estimated Cost /~ ..... ~ ...................................................... 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 e?ch type of use ............................ 7. Dimensions of existing structures, if any: Front ........~?,~.~ ........... Rear ......-~....~.~. .................... Depth .....~.R.. .......... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ .................................... Rear ............................ Depth 8. Dimensions of entire new construction: Front -~ ~- .... (( ................. Height /o Number of Stories 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Nome of Former Owner ........................................................ 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction violate any zgning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ....~.~..~ ........... Address .~.~.'"~r~" .~.)...~...~)~.~.~hone No ..................... Nome of Architect ...................................................... __~ ~x-- Address,~ ,') , ,~ · z ,,; ................................... Phone No ..................... Name of Contractor ..~,~.i:..7.9..~ .......................... Address ~...,~.....~,.~.~..$~,Phone No.~...c..~..Z~.~..~.~. PLOT DIAGRAM Locate clearly and distinctly oil 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 YORK /e e COUNTY OF ....~..~',.,~'./~,q.,Z~/~. ............. ~,~, ~ ......................... C~f~Z....~....Z.~.f~ .......................... b~i,g d~ly ,wo~,. d.po,~, ~,d ~w, that he ~ th~ ~ppl~ (Name of individual signing application) ~bov~ ~m~d. H~ i, th~ ...................................................... C.q..~:Z.~.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 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 ..... Z2..Z.~. ...... dw of ........... ~.~.~ ...................... , ~.~..Z.~~~~ C~, ~.. ~ , . ............... ~ .......... ~.~.~ .......................................... Notary Public,~~ ...... ~[X,~.F..KT~ty (Signature of applicant) ~ ~ ~ARY PUBLI~, State el 'New York ~o, 52-7267800 Suffolk Couz~iy ~i~ Expires March 30, 196~