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HomeMy WebLinkAbout3608-z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. P. EI~TIFIC:ATE DF DE:E;UPANP. Y THIS CERTIFIES that the building located at WeSt:..ShO:~e..D~C~,Ve .......... Street Map No~IrdOr~ ..... Block No ............. Lot No. 4 ... ~BOt~O~ld~ · Lo. Xw~ · l~o.]f~ ...... Sho conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated ....... ~pt~o..7 .......... 19.~. pursuant to which Building Permit No. dated ...... 8~t:...It .......... 19~7., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy f~or which this certificate is issued is ... ~.~.V~t;~..0~. ~]4~. · dwe].l~.~lg, w.i'~b..a~e~o~.y .btt~.].~li~lc3 ........ The certificate is issued rio ...... ~°..Ce~,~ '~O~R~ .......................... (owner, lessee or tenant) of the aforesaid building. ~Suffolk County Department of Health Approval ..... ~'. I';~ ........................... FOl~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) N? 3608 Z Permission is hereby granted to: eTohz~..off.an A/¢ Cee:Jl:Ja l~o£~n ................... ~utlu~l~! .......................................... to . I~,S _'1,4 .~..;~r~v,~te..~a~e .............................................................................................. at premises located at ...... ~Of,.J~.....l~li~)r~l~..~l,~8 ...................................................................... .................. · /5 .......... Wesf...~hor~..~)~'. ................ ~kl~ ....... ii.~;o ......................................... pursuan¢ to application dated ................................ ~o~t .......... ~/......, 19..~.., and approved by the Building Inspector. Fee $...~..'..~ ............ Building In[pector / OWNER FORMER OWNER TYPE OF BUILDING FARM [ COMM. , IND. j~ CB. i' M!SC. ! Est. LAND Farm BUILDING CONDITION NORMAL BELOW Value Per Acre ABOVE Value FRONTAGE ON WATER FRONTAGE ON ROAD Total House Tillable 1 BULKHF. AD Tillable 2 DOCK Ti!~oble 3 t , Woodland Swampland Brushland'''~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ~'J 19 /'! Permit No. ~ O ~ ~ Disapproved a/sc ...... ~ ................ ~ ................................................. / APPLICATION FOR BUILDING PERMIT °ate ........................ , 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 wilt 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 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, ordinances, building code and regulations. o ........................ /~ (S'gncture ~pp~t, or n~me, if a corporation) /~ V ~ / ~ ¢~ CJ/~C*__c~/ ~c~ ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~me o{ owner of premisos ... ~m~.~ ................................................... If opplicont is o corporote, sion~turo of duly outho xed officer. (Name and title of corporate officer) ~,~/ 1. Location of land on which proposed work will be done..Map No.: ...... (Z....~..~..y...~..~.~. Lot No.:-~.l. ................... Street and Number ....... ~ ..~......~...~.~,~.~....~.~-., ............. ~<'?.~.~.~..~.~.?.....~.~..~.~.'.~.~..~.... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed c6nstruction: o. Existing use end occupancy ........ ~.L.~. ........................ ....................................................... b. Intended use and occupancy ........ Z~..,,~'~.J.~. 3. NatUre of work (check which applicable): New'Building ...... ~.. Addition .................. Alteration Repair .................. ~/-- Removal .................. Demol t on .................. Other Work (Describe) 4. Estimated; Co t ........................................... o- 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. ~f Dlusiness, commercial er mixed occupancy, specify nature and extent of each type of use 7. Dim~ensions of existing structures, if any: Front ........ ..'~...~.. ............ Rear ....... ~...~.. ................ Depth .~....'~... ......... Height .....,Z.~.. ........... Number of Stories Dimensions of same structure with alterations or additions: Front ....................................Rear Dep,~h ................................ Height ............................ Number of Stories ................................ 8. Dh~ensions of entire new construction: Front .......... ~.~.. .................. Rear ........ /...~.. ............ Depth ..... ~..~ .... Height .../~... ......... Number of Stories ........ /. 10. Dat~ of Purchase ........................................................ Name of Former Owner 1 I. Zone or use district in which premises are situated 12. Doep proposed construction violate any zoning law, ordinance or regulation? ....... Nar~e of Architect "Address Phone No. PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block number or description according to deed, and show street names and whether i~ erior or corner4ot, _~_._ ~ .......... STATE OF NEW YORK ~,'c c COUNTY jOF ....... ................. L; .............................................................................. being duly sworn, deposes and says that he is the applic, l(Name of individual signing application) above nar~ed. He is the (Contractor, agent, corporate officer, etc.) of sa.d ow, nar or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and belief; that the wbrk will be performed in the manner set forth in the application filed therewith. Sworn to b, efore me this Notary of applicant) No. 52.06.[ SuhroIk Commission [xprres q 'Z '4 .?