The URL can be used to link to this page

Home My WebLink About3561-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFII:)ATE rlF OCCUPANCY No. Z .297.6 .... Date ..............Jan .... 2 ...... , 19..68 THIS CERTIFIES that the building located at .S../.S..D.c..cp..H.q.l.e..D..r.~y.e. .... Street Map No..x:c ...... Block No. xx ......... Lot No..xx.:...~&ti%uck~. N.,Y. ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..........August...3., 19.67. pursuant to which Building Permit No..356.12. dated ............ aug. · · ~- · · ', 19 .~7-, was issued, and conforms to all of the reqi~ire~ ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .. Pr. iv;:.ta .accassor.~ .Bi~I[~. (sta~age.) ................................ The certificate is. issued to . .Philip.. ~rl~lll~r ....... O~4~ler ........ ; ............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... ]~ .H,. [ ................. ~ ....... .... ......... Building Inspector ( 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? 3561 Z Permission is hereby granted to: ............... ~..~ .......................... .................... ~..~.x.......~v.... ........................ ...................... ~.~ ................................... to ..~M,..~..~.*...'..'...~..~.....~..'.~...b..~.Z..~....~....~. ............... : ............................................. at premises located at ~.~.....~[~l~.q~..~l~.....~t~l ............................................................................ ~tt~t~ek pursuant to application dated ........... : ............ ~.~. ........ .~........., 19..~..~..., and approved by the Building Inspector. Building Inspector .% FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ' ~ 19 r' Permit No. '~ '~ / ~ Application No. 3 .~C' (~ / Disapproved a/c ...... L..~,~,,.~...7.-), ............................................... ................ ................... ............ - · (Building Insp/ector) APPLICATION FOR BUILDING PERMIT Date ............ .~./..~. ...................................... . 19~...~.: ..... 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 ad)oining 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 o 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. ........ 4 ~ ................ ~" .......... ~"~f'~'~i~ ........ g .................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumb L~or e~ builder. ...................... ~.~ .............. ~ ......................................................................................................................................... Nome of owner of premises ....... .~Z.~..,..~:...~.~(~ ................................................................................. 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.: ~.~L.~.~..~,.~.:]~'.~. Lot No.: ........................ Street ~.d N.~be~ ~.~. ~C~..~ ~¢ . ..................................... ~;~'~:~'~r' ........................ Store existino uso ond occuponcy of promises ond intended use ond occupancy o~ proposed constructbn: o. Existing use and occupancy ~ ~ ~ ~ ~ ~ ~- D b. Intended use and occupancy ................................................................................................................................. 3. NatUre of work (check which applicable): New Buildin9 ~'/ Addition Alteration Rep~?ir .................. Removal ...~ ............. Demolition .................. Other Work (Describe) 4. Estimated Cost .........~...~..~ ......................................... Fee ..~.! .............................. (to be paid on filing this application) 5. If d?elling, number of dwelling units ............................ Number of dwelling units on each floor If g~rage, number of cars 6. If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dirrlensions of existing structures, if any: Front ............................ Rear ................................ Depth HeiClht ........................ Number of Stories ............................................................................. .J. Dirqensions of same structure with alterations or additions: Front ....................................Rear Depth ................................ Height ............................ Number of Stories ................................ Rear ..../.~ .................. Depth ../mc... 8. Dimensions of entire new construction: Front ....... /..¢.../. ..................... Height ~,r Number of Stories / 9. Siz~ of lot: Front ............................ Rear .................................... Depth ................................ 10. Dat~ of Purchase ........................................................ Name of Former Owner 1 1. Zor~e or use district in which premises ore situated 12. Doels proposed construction wolate any~n,ng iow, ordinance or regulation. 13, Nar~e of Owner of premises .~:).~'L././.~9.....~....~./..~....~.Address ...~..'¢:...~..~..¢.../.(;......~....~.r.../~...~...;~.~diC~Sne Na~e of Architect ......... % .................................. Address ............................................ Phone No. Nar~e of Contractor ....... % ................................. Address ............................................ Phone No. ] PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property I(nes. Give street and block number or description according to deed, and show street names and whether in~erior or corner lot. ,/ COUNT' OF ....~...°~..:...c¢~..:..,f ' ' ~" ~- ~/:,,¢_¢_~ ~..~...~~'~.. ........................... being duly sworn,/`- [Nanl[Cof individual si ' :pplication) deposes and says that he is the applk above na~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 make and this appli,:ation; that all statements contained in this application ore 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 [ efface me this ~ ,/,,~ da of ................ ;....,.. y ................................ ....... , ...... ,.......!,. Notary Public, . ........................................................... County (Signature of applicant)