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Home My WebLink About3530-zFORM NO. 4. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y, CERTIFIBATE BF BEIDUPANDY No..Z. 29.~ .... Date ............. 0Ot;ohe:C...27, ,, 19.67. THIS CERTIFIES that the building located at Pine, .Eeck .Bd. & .Oa~liner. s S~eet Map No .... .~:f~ . Block No .... ,,T45~c. ..... Lot No... XX~... ¢.q't~l)hp.],cl...~,.Y., ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 4't~¢...2¢.. , 19.67. pursuant to which Building Permit No. 3~3Ct dated .......... ~P4~?.. ¢5 .... ,19. ¢?., 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 ..... l~l,!Xa.t., .e..o.n. 9' ?.a.m. 4._,.11.~..d.~LeJ_;k~j;g ................................... The certificate is issued to . .lflgt.z~:[O. ~.oSt;Oll ....... .(hc/~e~. .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... 0ti;...26...19~5/..b~'...g,. Y. llta Building Inspecto[ FOP.~ NO. ~ TOWN OF SOUTHOLO BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST'BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE ~tORK ^uTHORIZED) 3530 Z Permission is hereby gran(e'd to:' ::.~::.~.~.,,***~. .~,.~..~.....~,..~ ...... pursuan¢ to ,application dated .................. .....:~J~..:.,~.:.- ........... , 19~!..., and approved by the 'Buildihg Inspector. ' ' Fee $....~,..e....~... .......... Building Inspector / SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da.re Bldg. Permit No. TO WHOM IT MAY CONCERN: at The se~g~ disposal facilities for ~-~tructure located '-- (Give deed locati~n-~ ~ d have been inspected by this department and found to be satisfactory. District Engineer T~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S O~:FICE SOUTHOLD, N. Y. Approved ........................................ ,19 ........ Permit No ........ .~....O......~. Appiic.ation No. '":~ ~' ~:~ O APPLICATION FOR BUILDING PERMIT Dote ........................ 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 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 Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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, ordinc~ces, building code and regulations. .~ ~M-5,-x,...~..~;......._....~. *~4 ............... (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 £f/~'~-- ~'' -: If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed wo~r~k will be done..Map No.: ......................... :~ ............ Lot No.: ........................ Street and Number .....~.~,~/~..-.~-~.~...Z.~,..~.*-.:~.....~.....~...~Z .................... ~.~~...~ .................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. E×istlnguseondaccupancy ......... ..................................................................................... b. Intended use ond o¢cuponcy ...... :~.~.~..:-r.~.. ............................................................................... I_ocot property I whether i'n 3. Nature of work (check which applicable): New Building ..... .~...... ..... Addition .................. Alteration Rep;air .................. Re~moval .~ .............. Demolition .................. Other Work (Describe) (to be paid on filing this application) 5. If c~welling, number of dwelling units ....... Z. ................ Number of dwelling units on each floor If glarage, number of cars ............. 6. If business, commercial or mixed occupancy, ' specify nature and extent of each type of use 7. Dir~ensions of existing structures, if any: Front ............................ Rear ................................ Depth Heibht ........................ Number of Stories Di~ensions of same structure with alterations or additions~ Front ....................................Rear / Del]th ................................ Height ............................ Number of Stories ................................ 10. Dai,e of Purchase ........... ~'... ~..,Z.. ............... Name of Former Ownel 11.. Zoq,'e or use district in which premises are situated ....... 12. Doe;s proposed construction violate any zoning law, ordinance or lotion? ..................... T ........... Phone No.,I ' Na~ne of Architect ......... ~ .................. i...... ........... ~Address ............................................ Phone No. No~ne of Controctor ..~ .......... .~. .... ddress ...... Phone PLOT DIAGRAM ~ clearly and distinctly all buildings, whether existing or proposed and indicate ail set-bock dimensions nes. Give street and b oc¢ number or description according to deed, and show street names and ~erior or corner lot. STATE OI NEW YORK ~ S S COUNTY OF ................................. ~' ' ' ................................................................................................ being duly sworn, deposes and says that he is the applic j(Name of individual signing application) above nor~ed. He is the (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to rnake and this oppli~aHon; that all statements contained in this application are true to the best of his knowledge and beIief; that the w~rk will be performed in the manner set forth in the application filed therewith. Sworn to ~efore me this ~, _ ~ ) _ VNOT~Ry pUBLIC, St,t0ff,, ~o'nt" "~erm Expires ~arch ~N OF SOUTHOLD BU I:kDING DEPARTMENT TO~N CLERK'S OFFICE SO~THOLD, N. ¥. ....... ...... ........ Approved ........................................ , 19 ........ Permit Nb. ~'~ ~ ~)~2~ Disapproved a/c .............. ~'~'"~-~ ......................... ~,~.:....: ...... ~ ............. .................................. ................................. Application No. "~ ~ '50 APPLICATION FOR BUILDING PERMIT Date .......................... 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 property must be drawn on the diagram which is part of thi~ 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 Occupancy 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 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, ordiq~nces, building code and regulatlo~:~ ,~ ................ (Signature of applicant, or name, if a corporation) (Address of applicant) State whether a~plicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............ . .L~..~.....~..: ............................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on white, proposed w~o_.r.k will be done. M,0.P No.: ....................... ~ .............. Lot No.: ..; ..................... Street and Number ~~....~::;~..~ ..................... ~~~X .................... Munici~ity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ~xistin~ uso ond occupancy ...................... ~~j ............................................................................................................ ..... ................................................................................. 3. Nalure of work (check which applicable): New Building, ........ Addition .................. Alteration Rep',air Removal .................. DemolitiOn .................. Other Work (Describe) 4. '"i ') (to be paicl on filing this application) 5. If iwelling,, number of dwelling units ........ ~.. ........... ;,...Number of dwelling units on each flaor If ~aroge, number of cars ............. ;~/.....' ................ 6. If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dinhensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Rear De~th ................................ Height ............................ Number of Stories ................................ 8. Din~ensions of entire new construction: Front ......... ~.....~.. ................ Rear.....,w~'....~-. .......... Depth .....~...~. ...... Hei,~ht ...... ,~..~, ....... Number of Stories ............. 10. Dale of Purchase ......... ~/~'~"¢~""~"7' ............... Name of Former Owne~..z 11, Zoie or use district in which premises are situated ....... ,~ ................................................................ 12 Does pro osed construct on v olate an zon n ow ordnance or re ulation~ NaCne of Architect ..........::: ........ "ii'i[....,.; ................... Address ............................................ Phone No .............. ..1~ / PLOT DIAGRAM I_ocaf, e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f~m property Ilnes. Give street and block number or d~,scription according to deed, and show street names and indidbte whether i,n[terior or corner lot. STATE al NEW YORK, COUNTY OF ................................ ................................................................................................. being (Name of individual signing application) above nalhed, He is the of said o~ this oppli, duly sworn, deposes and says that he is the applk (Contractor, agent, corporate officer, etc.) ~ner or owners, and is duly authorized to perform or have performed the said work and to make and :arian; that all statements conta'ined in this application are true to the best of his knowledge and belief; that the ~ ark will be performed in the manner set forth in the application filed therewith. Sworn to b,'efo~:e me this .......... '~'~ ~'"~"~'~ '~ /~ /r,_O,~ . ~,day of ........ Notary Pcblic, ..~..'~.t,¢~.f.'VJ....~t....,~,~'.~//~;~%~'.¢. ........ County ' ~g~4~ture of applicant) ~J~ MARION A. REGENT , NOTARY PUBLIC, State o[ New york ~o, 52-3233120 Su[fo~k Cour~ty~ ,Term Expires ~tarch 30, 19~