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Home My WebLink About3370-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE ElF BBBLIPANr. Y No. Z 2890., . Date Oct:obex~ 20 .. , 19 ~? THIS CERTIFIES that the building located at J,I, LL~I. Creek. Drive. Street Map No.x:~X Block No. ~ . .Lot No. ~[X · ' Axshamomaque~. I~,.Y. conforms substantially to the Application for Building Permit heretofore filed in this office dated January 30 . , 195~t pursuant to which Building Permit No. 3:~?t~ 2; dated Jant~aXy 30 ,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 ~te~,.ll.,,.,%m&~l., · ·. relo~&t:~ 'one' -fami~;y' dwellit~g ............ The certificate is issued to ....... lo]~e~c~:. ~,,..Au;l-cl., O~t~e~ ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of I-Iealth Approval .... ~ ................. FOF,~ 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) 3370 Z Permission is hereby granted to: .... ~..~..~S,~h.. AZ.C...ItO. kt;...k~d ............. .................... ~uth~14 ........................................ to ~..qY.#...~..~;;I,~J~,~ ..~.e;~l,;Lo,&..f~...t~a~.. ~o ca~on..~ ..D~de...~t ......................... at premises Iocoted at ~L~1'1 ..~e~Jc..~...&..~&(~l~'-g..,T~. ............................................................... ........................................... ~lo~tt, l~;l~,.....~. ¥ o ................................................................................ pursuant to application dated ........................ ~T~D,I~B-,--~r ........ ~. ........ , 19.~,.., and approved by the Building Inspector. NOTI~I Approved by ]~:t. Appeall .......... d 80.o[0: bo'=/'" FOEM NO. 1 Examined ......................................... 19 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c .............................................................................................. Application No .......................... (Budding Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or m ink and submitted in duplicate to the Buildir Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and g~ving a detaded descnption of layout of propertymust be drawn on the d~agram which is part of this applicatio c. The work covered by this apphcation may not be commenced before issuance of Budding Permit. d Upon approval of thru application, the Building Inspector will issue a Building Permit to the applicant. 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 ~n part For any purpose whatever until a Cerhficate of Occupan shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to t Building Zone Ordinance of the Town of Southold, Suffolk County, Flew York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with all apphcable laws, ordinances, building code and regulations. William B. mith (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general controc.,tor, electrician, plumber or build ' Name of owner of premises . .~..O..~...e.?...~...~.,..~....'~.....0, ................................ ~ ................................................ If applicant ~s 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' . ............... .~ .................... Lot No' ...~ .... /. Street and Number ..~.;~..~.~.~ ~..;[.~.~...~..~.8.~.O.~r..~f~ ........ ~.~.~,~Q;],~[ ........................................... Municipality 2. State exishng use and occupancy of premises and intended use and ogcul~ahcy of proposed construction: a Existing use and occupancy ..... ~.~,~;~g ............ I~ ..................................... b Intended use and occupancy ..... ~.~-~1~...]~.0; ..~...I;;.0..~.~.~ ,,3,f).¢.&.l;;.,~,~3~ .................................................. 3. Nature of work (check which applicable): New Building .................. Add~hon ................. Alteration .............. Repair .................... Removal .................... Demohhon .................... Other Work (Describe) .... 4. Estimated Cost .... ..~.¢...~c:.~ ................................... Fee .-.~.O~(X) ....................................................................... (to be pa~d on filing th~s application) 5. If dwelling, number of dwelling units .-G~I~ ..................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 D~mens~ons of ex~sting structures, ~f any: Front ........ ~ ............. Rear ...~,,~ ................... Depth ......-~2 ............. Height ............................ Number of Stories Dimensions of same structure with alterations or additions: Front ................................ Rear ............................ Depth .............................. Height .............................. Number of Stories ........................................ 8. D~mensions of enhre new construction· Front ............................ Rear ............................ Depth ........................ Height ............................ Number of Stories ........................... 9 S,ze of lot. Front ..~.].~0,,~..~/t(]..'..t~...'J~.ear ........... .~(:~ .......... Depth .~,,~'. ....................... 10 Date of Purchase ........................................................ Name of Former Owner .................................................... 11 Zone or use d~strict m which premises are situated ..... ~/t~fl...~..i.~ .................................................................... 12 Does proposed construchon wolate any zoning law, ordinance or regulation:~ ........ ~.e.~ .................................. 13. Name of Owner: ~bf remlses~O'b~ ~.U..1L~ , ,, p ........................................ ~aaress ...... 84:~U,t~;Lc~ .................. Phone No ................. Name of Architect ...................................................... Address ............................................ Phone No ................. Name of Contractortff~,...]~,,...~'t.'[.~ ........................ Address ........ ~O~t~}~4:~;~ ................ Phone No..~...~'...~...~.. PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing ar proposed, and indicate all set-back dimens,ons property hnes. Give street and block numbers or descr,pt~on accord,rig to deed, and show street names and indm, whether ,nterior or corner lot. STATE OF NEW YORK, COUNTY OF .... .............................. ~/L1._'t'l JL~:t..~,...~,:~:~ ............................ being duly sworn, deposes and says that he is the app (Name of individual s~gnmg apphcation) above named· He is the ........... D~Z'~.a~ .~..~g~ .................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make an thzs apphcation; that all statements contained m this apphcation are true to the best of his knowledge and I and that the work will be performed in the manner set forth in the apphcation filed therewith. Sworn to before me this ,// ~ ~ -- .................. ~ ...... dayof ................ ~~ .......... , 19- ~.. / [/ , /~/~ ,, '. ~ ~ ~ ~ /, ~ I ~ · ~,.~...~~~ ............. ~..~~,~.S.~ Nota~ Public, ......L.h~..~...~.:...~.~~ounty ~:~,: ~,~ (Signat0re of applicant) ........... ~ ~OTARY P6~d , ~:a e ~ H~,v ~a~ ~o 52 3233~20 Su.~N~ Ccu~ ~erm ~res ~ar~ 30, t~