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Home My WebLink About3537-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P, ERTIFIE:ATE nF E]r':r:UPANP. Y No. Z. 2~8 ..... Date ............... ~l!g~. 8~ .~0.., 19..67. THiS CERTIFIES that the building located at ~q/~ .~a~l~e3,. AN~e ........... Street Map No. :~.-.~.-.. . Block No... X~ ..... Lot No..XX~,... f{.o~:d;tlpJtd,. I(~Tf, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~t~ ... J.0. , 196~. pursuant to which Building Permit No. 3~3.~.g.. dated ....... ii'Iii.7'... J,0 .... , 1967.., was issued, and conforms to ali of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is P~V{~ .0.I1.e. .ff.-~.:[.]:.Y...cl.~.e.~.~.~.~.g ....................................... The certificate is issued to .9¢~*. ~,.o..Ogf.~[g~ ......... .0.~. ...................... (owner, lessee or tmmnt) of the aforesaid building. Suffolk County Department of Health Approval ...N~.RP ..... · ....................... Building Inspector FOEM NO. ~ TO~N OF SOUT~OL~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Il. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? '3537 Z Permission is hereby granted to: ..... ~b~.. ~_ ~e~*~e,....~.~ ...,~..~ ..G~Zt~ ...:.. ............... ~.~.~l ..................................... ;~.. pursuan¢ to appllcati'on ~lated, .................................... ~.....~..~:., Jg.../~/~., and approved by Jhe Building Inspector. F~e $...5..*,g~~ ........... FORM NO. 1 TOWN OF SOVTMOLD B~JI~.DING DEPARTMENT TOWN CLERK'S O~:[:ICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No. Disapproved a/c ....... ~~' . ........... ~.]~>. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitS'ed 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 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, ordinances, building code and regulations. John Hago~ic (Signature of applicant, or name, if a corporation) Southold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. .................................. ,g.o..n..¥..r. .*., ................................................................................................................. Name of owner of premises Geor§e L, Ga££ga If applicant is 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 ...~../.~......J.%~.~.z/..e.~..?.z.e. ....... ..~..o..~..'.c..~...o.~ ................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....d....~..e..1.~.~g ................................................................................................. b. Intended use and occupancy ............ ~r~ ......Z~,.~,..~C]~g..~.~,f~ ....................................................................... / 3. NatUre of work (check which applicable): New Building .................. Addition ....~...~...~.....:,~C.. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ....~.~..9.....~/..~ ..................................... Fee ..... ~.0..0 I (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... O2'18 ............. Number of dwelling units on each floor / If ghrage, number of cars ............................................................................................ 6. If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dirdensions of existing structures, if any: Front ............................ Rear ................................ Depth Hei]ght ........................ Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Rear De4th ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new constr'uction: Front ........... ~ ....................... Rear ......... ~ ................. Depth ........ '1.~. ..... Height .................... Number of Stories ..O.D.~ ..................................................................... 9. Siz~of lot: Front ............................ Rear .................................... Depth ................................ 10. Dot~ of Purchase ........................................................ Nome of Former Owner 1 1. Zone or use district Jn which premises ore situated ........ 12. Do? proposed construction violate any zoning Iow, ordinance or regulation? ..... ~.o 13. No'ne of Owner of premises ...~..:..~..:.G...~..~.p~.~. .............. Address ...~.D.~'~0.,'L.~I, ....................... Phone No. / Nar]ne of Architect ...................................................... Address ............................................ Phone No. / J · Ha'0onic A Southold No e of Controctor ...................................................... ddress ............................................ Phone No. PLOT DIAGRAM Locat~e dearly and distinctly all buildings, whether existing or proposed and indicate ail set-back dimensions property I!nes. Give street and block number or description according to deed, and show street names and whether i,nierior or corner lot. STATE OF] NEW YORK, 1. ¢ ¢ COUNTY]OF . ~.'B.~;~.9. ~ .............. ~' "~' ......... Jo~ HaRonic being ....... /~'~;'~'~]~i~'~'l'~J~'~'~'l]~]~ ................. duly sworn, deposes and says that he is the appH~ ] ,, abow~ na~ed. He is the .......... C~.~a (Controctor, agent, corporote officer, etc.) of said owner or owners, and is duly outhorized to perform or have performed the sold work ond to make ond this appli¢otion; that o~1 statements contdned in this opplicotion are true to the best of his knowledge and belief; that the ~ork will be performed in the monner set forth in the applicotion fi~ed therewith. Sworn to ~efore me this ................ ~..!.~ day of ...................... Notory Pu~lic~~....~.,...~.~ County of applicont)