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HomeMy WebLinkAbout3483-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. OERTIFICIATE OF oE:r. UPANP. Y THIS CERTIFIES that the building located at OSp~*~' .IJOS~ .BIII~ ......... Street Map l~o?&Y~..11 .~. !~oc~ No ............. Lot No. ~! .... ~'I~0OZI;ii .ll...~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. N,a~.. ~,., 19 '67' pursuant to which Building Permit No..~1~. dated ............. )lay...1],.., 19~6~'., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . ]l~l,~a~ .O~1~ .f.a]lll.'Ly. ~,.ml'l~g. ...................................... The certificate is issued to .l)]ro. Arl;h~]~. P©~]~i~L~I .... O~10~ .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... ~,...~ .................. Building Inspectork FOR~ NO. ~ 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 WORK AUTHORIZED) N? 3483 Z Permission is hereby granted to: .~.,,...;~,.:~.. AZ.~..~ ..~e~,~ .... ............... .~.~l;)x~k4, ,.....~.,.l(..: ............................. to ~lFtLtld ~ &dd~tion on an ex~st:Lr~ d~Zl~n~ at premises located at ....~..0...~......,~..~.. ...... .,~.,~.,~..~....1~....~.....~.....~..~......~.......~. .................................................... .................................. .O.~r...~..m..~.....~... ....... ~.e.e~..e~.~.....~....~... ............................................... pursuan$ to application dated ............................. ~ ......... ~ ........... , 19..~..., and approved by the Building Inspector. Fee $.~.~.~. ............. FO~M NOol TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. Permit No. ~/~/~ '~ ~'~' Application No ......'..,;,~..~.',.,-~. .......... Disapproved a/c ............................. ........... t..~ ........... ~ ........... %:.u:-',, ............................................. ................. ./.....'-.::'::~i~:Z.~:.'L/.. ........................................... ' (Building ~spector) APPLICATION FOR BUILDING PERMIT Date ....~.~ ........ /. ........................... , 1~...../2..... 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 p~emises, relationship to adjoining premi.ses 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 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 shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupano/ shall 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 ofxthe 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, b~lilding code and r~gulations. · ........ ...... ...~.~...../~....../~..~...¢.....~..,.,. ~/z,//) .... / · '~ /(A~ddress of al~plicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... .~.u.,...l..a.,,z.~.. .................... '. ................ t. .................................................................................................. Name of owner of premises ....~../~...:.....~.../,~...~..~ ..~....d..~. ~Z~.. ~, U ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .~.!..~.~...~..~.~.,,~.../~..~.~ot No.: .../~.., ......... Str, et and Number .../~ ...... , ..... .~./~./....~.~.S.Z~.IPffi ........... ~.~.~..0~ ............... / ' ~/ / Municipality -- 2.State existing use and occupancy o{ premises and intended use and occupancy of propos~ construction: ~. ~,,~ ,~e ~,~ =,~ ~ ~U.~ .~;.a ~* lX ..~.~..~: ........................ 3. Nature of work (ch'eck which applicable): New Building .................. Addition ..... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (D~gcribe) ........ : ............................... 4. Estimated Cost ..... ~.~.~..~..~....~... ........................ Fee (to b~ paid on fil~g this app icat on) 5. If dwelling, number of dwelling units ............................ Number of dv~elling units on each floor If garage, number of cars ...................................................................... i ...................................................................... 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,~.~/. .............. Depth ....~....~..__ ..... Height ...... 4~."~"/'~ ....... Number of Stories ....... .~ ............................................. ' ./. ............................................ ' .......... Dimensions aT same structure with a.lterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ....~:,?. ............... Height .................... Number of Stories ~. 4~ 9. Size of lot: Front ............................ Rear ............ l. .................... Depth ........ ~.D...~. ............. 10. Date of Purchase /..~.'~. ................... ./....~'...?Name of Former Own/er ....................................................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Owner of premises ........................................ Address ........................... ~.,...~..~,..~hone No. Name of Arch tect ........... ..'~....~....~'~...~...~.??...~.../..~...~..Address .!..~....~....~.~../....~.. Phone No...~../~..~..~.~ ......... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly ali 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. I (Contractor, agent, corporate officer, etc.) of said owner or owners, '&'Rd is dul~'authorizecl.?o perform,or have performed the safd work and to make and file this appticat on; that all statement'~ contained ir~"this application are true to the best of his knowledge and belief; and that the work will be~erformed in the manner set forth in the application filed therewith. Sworn to before me this ' . ....... /_.. ..... ........................ day of ............................................ , 19 ........ ~ ' Notary Public,. ........................................................... County Z::~'~ ' ~ o~'''"'''