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Home My WebLink About3371-zFORM NO. 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE OF OBDUPANBY No.~ 3030 . Date.. April 5,.. , 19.68. THIS CERTIFIES that the building located at N/B New Su£f, mlk Ave. Street Map No. Block No. .Lot No. M~. ,tti.t.u~.k.,..L., I., ,.~: .Y, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated Feb,. 1, , 19. $~ pursuant to which Building Permit No. Z. 33'2'1 dated l~eb, ]~, .. ., 19 6?, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is ~ssued is .... p. ri.v.a.~.e.. 9.n.e...f..~l.i..ly..c~e..ll.il~g ............................ The certificate is issued to .M~.o &...M~..s.~ .G.e.q.rg.e...1~..~1'1~..~.I.~. ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County ]Department of Health Approval ' I'~' ,(/- .~~, ,,,:.~...',:,.... ~... ..... Building Inspector / FOR, I~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 3371 Z Permission is hereby granted to: ............. ~eo~ 8~ .. ~nn~...I I~ ..Wif ~ ............. .................. New..~u~.Ee]~...A.~e .......................... ......................... Ma.%~ .~.%uek ................................. to ... ~L.~&,.e~., ~.t. %$o~..&-.t~eke..A~tte>a.%~..o~.. ~.. ®z&.a ~ .~..~l.~.$n{. ..... at premises located at ~l~.~...~w...81~ff.c~lk..Av.e .............................................................................. ......................................... Ma~t~.tu~kt....t~. I. ................................................................................ pursuan,t to application dated ........................... Fe]3ttl'&i~"'"l' ......, 19.6~.., and approved by the Building Inspector. Fee $-'~.00 ............. Building Inspector FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 7 Approved ......................................... 19 ........ Permit No ................................. D~sapproved a/c ............................................................................................. (Building nspec or) Application No. 3 ~ 2 { APPLICATION FOR BUILDING PERMIT Date .................... L'.;~..~~, ......, 19..(.'Z.~... INSTRUCTIONS a Th~s application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin[ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o. areas, and giwng 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 Budding Inspector will issue a Building Permit to the applicant. Suc} permit shall be kept on the premises available for inspection throughout the progress of the work. e No building shall be occupied or used m whole or in part for any purpose whatever until a Certificate of Occupanc; shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Budding Permit pursuant to th: Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all applicable laws, ord~nance~s~ building code and regulations. (Signatur~of applicant, or nam~ if a co~oration) ........... ...... (Aaa .ss o[ applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, el~tncian, plumber or builder N~me of owner o{ premises ........ ~. ...... 5 ......... ~ ........................................... ff opplicont is o corporote~ siOn~ture o{ duly outhonzed 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 /b: ~u~ ,~,_~ ~ , ~-~¢~ ~:~~~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b Intended use and occupancy. 9~,~..~ ..~.v../'..~,' bz~ ~ ~ ** L, .~. 3 Nature of work (check which applicable). New Building .................. Addition .................. Alteration ................. Repair .......... ~ .... Removal ..... ~ Demohhon ........ ' ....... Other Work (Describe) ~ .......................... 4. csr~matea ~os~ ................ hv..~ ...................................... ~ee ......................................................................................... (to be pa~d on filing th~s apphcation) 5 If dwelhng, number of dwelling units ............................ Number of dwelling umts on each floor ........................... If garage, number of cars 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use ................ ~ .............. 7. Dm~ens~ons of existing structures, if any: Front ......... .c...C...! ......... Rear ~ Depth Height ........... 7¢...~.;. .......... Number of Stories ............. f...'./.....~. ...................................................................................... Dimensions of same structure w~th alterations or addmons' Front 6F ''~ Rear Depth ........... .~....~. ............. Height ........ .~..~. .............. Number of Stories ..... ?....!.r....-~.. ........................ 8. D,mens,ons of entire new construction: Front ...... ..~'...'..?.. ............. Rear ....... ..2.......~... .......... Depth ...?:'.....?.. ............... Height .......... ~..~% ............ Number of Stor~es ....... J...~.!....u~.. ........ 9. Size of lot: Front ......... ~....~...~.:. ...... Rear ....... ~..~..2....~. ...... Depth ....~ ........................... c'~ ~ ~ Lt 10 Date of Purchase ................... ./. ................................... Name of Former Owner ....................................................... 11. Zone or use d~strict m which premises are s~tuoted .......... ,~...~...~.~ ..................... 12. Does proposed constru~:tion violate any zon,ng law, ordinance or regulation? 13. r~ame o~ uwner ar premises ................~:...2 .......... 7/4....ftaaress .............. :..(/% ................ ~ ..... Phone No .... r.~..".¢.:..~..~ l'¢ Nome of Architect ........ : .............................. , .............. Address ............................................ Phone No ................... Name of Controctor .................................................... Address ............................................ Phone No ................... property lines. Give street and block numbers or descri whether interior or corner lot. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fror )tion according to deed, and show street names and ~nd~cat COUNTySTATE OFoFNEW~RK, ~ ~ S S ~ ~ ~--.~ ....... · · ............. ~'~ ...... "';~,'"'~:"W'"'7{~ .............. be' g duly sworn, deposes and says that he is the applica (Name of ino~viau~ s~gning appucar~on~ above named. He ~s the -- (Contractor, agent, corporate officer, etc of said owner or owne~, and ~s duly authorized to perform or have performed the sa~d work and to make and f th~s apphcation, that all statements contained in this apphcation are true to the best of his knowledge and beli~ and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this of ........ ./.~ ...... day .... ~~ ..... , ..........~...~ ..... ~..~~~ Nota~ Pubhc~,.jz...r,...~..~.~.., ..... /~.~,.~ounty (Si~ture of ap~ ..... ~....~ Term Exp~re~