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Home My WebLink About3510-zFORM NO, 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. r":.ERTIFIP. ATE ElF BP..P. UPANP, Y No..~. 28.8.9 .... Date ...... ,Oeto~).e~. ;~.0, ......... ,1¢.~... THIS CERTIFIES that the building located at ... llil~uad. ~ho~:e .Road ..... Street Map No..X~; .... Block No.. ~ ....... Lot Ndg~21; ......... Pe~oal~,~.¥. .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... June .? ........ , 1967.. pursuant to which Building Permit No..3516 .~; dated ...... ~t~rle. L0 ......... ,19.67., 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 ..... addition..to, one. £amily. d~el[5,,,v..g .............................. The certificate is issued to .... .8.at~vclX ./¢o~cj~ .-.. ¢~.~ ............................ (gwner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... N/fI~ ........................ Building I~pector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIzED) N? 3510 z Per'mission is hereby granted to: at premises located at .....~J~..~:,J~lr~..;~; ...... ,.~t~.'..'Z; ., ::"' ~ .... ~e:.,~e~--~~,r-...~,,,1,_ ....... :;.: ........ - ........ :,; ..................... ~..'.-~,'.;-?.; ............. pursuant'tO opplication dated ..... ~..;,~; ........... ;...,.~.~.~. ...... ~,~;,~:,:;~ i9,1~.., and:approVed by the Building Inspector. , . t.! ......... ,. ....... :..,..: .... '~'a~'-'"'" ",- :t .......... ~ Budding I ,~ r'r '' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OEFICE SOUTI4OLD, N. Y. APPLICATION FOR BUILDING PERMIT 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 odioining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is port 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 o Building Permit to the applicant. Such permit shall be kept on the premises ovai]obJe for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 and regulations. 1 '(3ignoture of applicant, or name, if o cor~or~r(ion) ...... .............................. (Address of applicant) State whether applicant is owner, ~essee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... . .&.'..~..(,' .~( .(-..Z. ........ .c..~.'.~..Z~..c....~.(?..8. .................................................................................................... Name of owner of premises ~"'~/~}/'//~' If applicant is a corporate, signature of duly authorized officer. ........... ..... (Name and title of corporate off'er) 1. Location of land on which proposed work will be done. Map No' . ........................................... Lot No: .................... 7Municipality ..................... 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 ..... ~ .;. ~.m .......................................... 3. Nature of work (check which applicable): New Building .................. Addition ....... f...... ..... Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (D ¢ribd ................ ._ ..... 4. Est mated Cost ?...~.. 0~, ~-~ 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 existing structures, if any: Front.....~."~....d(.i ............ Rear ........ ?....~,,.z. .......... Depth Height ...... ./.',.~...~ .............. Number of Stories ........ /. ........................................ Dimensions of same structure with alterations or additions' Front. ...... ..~..?'..! ................. Rear ....... ..J~..~../ ................. Depth ........ .~....~..! ............ Height ......j....b~.. ................... Number of Stories ....... ./. ............................... 8. Dimensions of entire new construction: Front .......... .~. ................... Rear ............................ Depth z'/2 Height ...... ~ .................... Number of Stories .................................. 9. Size of lot: Frbnt ........... ~.~ ............... Rear ........ .d'.?.j. ............ Depth ~ ~O r 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are stuated 12, 'Does proposed construction violate any zoning law, ordinance or regulation? ....... ..A~...b. ......................................... 13, Name of Owner of premises ....~.........~...O.!~..~..~ ............. Address ...../~..~.f:.q..~../.~ ................... Phone No. ~...~..-.r~.~? Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor j4f/?~-,L~J' ~z"/9'~,RT~V Address z::i,'7~/-/~-j//~ Phone No. P 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 YORK,,- COUNTY OF ............................ ) S.S, ,.......~../~...,z~ ..~~ ............................ being (Name of individual si~'n~g application) duly sworn, deposes and says that he is the applicant above named. He is the ...... .C....~.~...~'..~..~.6.'...7-.¢..(~ ........... ~¢,.....~.~,~ ............................................. :.; ............. ', ............................... ~.¢¢~t,~ ~;~tractor, agent, corporate of Ticer etc.) of said owner or owners, and is duly authorize,~,~,t~<,~l~.e~r~.~]/have performed the said work and to make and file this application; that all statements contain ~,x~gk~,,gt~i~0~icatlon are true to the best of his knowledge and belief; and that the work wilJ be performed in th~,p~_.~ ~T forth in the application filed therewith. Sworn to before me this ~ s?~s' ' ..... ............ ........ ................... No ry lic?..Y,./...'-.,C~ ........... J.~.-~...~'~.'~¢,~.. ..... County (Signatur,~'of dp~51icant)