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Home My WebLink About3523-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. OERTIFIP. ATE OF OOP. UPANOY No. ~ .293-9 .... Date ............. 0e~. .... 30 .... , 1967. THIS CERTIFIES that the building located at . .E/8...Main .Road ......... Street 1~. ...... I~.. - ............. ~Nv. 18Z,. 181+. l~t. 1~... Amshmque . . Qre orr conforms substantially to the Application for Building Permxt heretofore filed ~n tH~s o~]c~ dated ......... ~Tlme.. 2.2.., 19.6~'. pursuant to which Building Permit No..3~2.~ ~, dated .......... ,Tulle ..... 2.7.., 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 .Pm'iv.a%e. one. £amil.y..dwe..%J, ing ....................................... The certificate is issued to .C.&t'ol. Xl~e. l~bek ...... ~mer ........................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ N'~"R'. .................... ......... ' ...... ! FORM 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? 3523 Z Permission is hereby granted to: .......... .~.~.~..o.;~.~.~... 2~..e..k. .................................... to r~.,-., pc' 19.~..., and approved by the pursuan¢ to application dated ......................... ~..~, .......................... , Building Inspector. Fee $..5~0~ ............ ......... Build, ~ ....................... WILLIAM W. WETMORE Carpenter a~cl B~,~lder BAYSHORE ROAD GREENPORT, N.Y. 11944 FOKM NO, 1 Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ]~ ........ Permit No ................................. Application No..?......~....'~.....~.. .......... APPLICATION FOR BUILDING PERMIT 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 premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn on the d.iagram 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 pa rt For any purpose whal;ever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Bt]ilding 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 df buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) .................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .Q~. ~'.9..]~,q.~. ]~.b.e~ ............................ If applicant is a corporate, signature of duty authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .~.~./J.L~..~.~.t.~L0t. Street and Number ...~21~.~.fl...25 ...................... J.z'..~:~m4~ilu.e ................................................................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... .d,~.%~.;Lt:~J ........................................................................................................... b. Intended use and occupancy ..... r]W~]~].~l{[. ........................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition '~' Alteration Repair .................... R,emoval ....... ~ .......... Demolition .................... Other Work (Describe) ...................................... 4. Est mated Cost ~ .~.' .. Fee ~-, ~; (to be paid on filing this application) 5. If dwelling,, number of dwelling units ...o.~..~ ................... Number of dwelling units on each floor ......................... If garage, number of cars ................................ ~.....j ................................................................ 61 If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... ]....; ......... j .......... 7. Dimensions of existing structures, if any: Front ....... ~.! ............ Rear ....~,,~ ................. Depth .~l.t...~,J~! ........ Height ....~..~..l. .................. Number of Stories n,-~.~ . .................. Dimensions of same structure with alterations or additions: Front ...~ ........................ Rear ...~.! ....................... Depth ...3....~,!.../....~.6..! ........ Height ....]:.~..t ..................... Nurgber of ~tories ...Q~e...; .......................... 8. Dimensions of entire new construction: Front ....... ,/,,, ,~,, ........ I~ear ,,,,,~,,,~,., ............... Depth ].~t , Height ..... ~.~,,~ ................. Number of Stories ,,Q33,e ................... 9. Size of lot: Front ,,.4,~. ................. - Rear ....,~4~ ................ Depth .....~,~5 .................... May 1959 10. Dote of Purchase ........................................................ r~ame of Former Owner ..~..~.~IL~'~ ..................................... 11. Zone or use district in which premises are situated ... ,~. ~..{*. ~. ~.. ............ ~ ........................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..=O ............................................... 13. Name of Owner of premises ,,q~,,,r,,°.~,,~,',~,,e,,.~,,~,~,~,.,..Address,;~9.~Lt.~-~ ......... .o,; I,;~ t- .............. Phone No/e,?,?,,,~2,,71,),,,' Name of Architect ...................................................... Address ............................ ................ Phone No ..................... 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, ~ 'c c COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (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 Jn the application filed therewith. 'sSw°rn '° '~°re ~ae th~' ~ri~,,~,~,.,~,,:, ~d~~__ ~ __,, :~19l~' ~~; ~~ ~C, ~.V./. ,.~, ,,~,~~a] n~ pp ~ _ _ ~rm ~plr~l ~rGh 30, 19~ ....