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Home My WebLink About3626-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING D.EPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. ERTIFIF!.ATE nF OOOUPANr. Y No..Z.. 3.040... Date ....... ~plr~l .4, ........... , 19.68. THIS CERTIFIES that the building located at .380..O~k. St, .............. Street Map No. ~g~,. · Block No ............. Lot No. I18.. CatChog~e.,..L. l,.,. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... SePt...~ ....... , 19.6~. pursuant to which Building Permit No.Z-3&~6- da~ed ...... ae~t,..~ ....... , 19.6T., 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 .... ~va~e. one. ~y..~e~l~g. ~i~. a~eas~y, b. uil~g ...... The certificate is issued to ..... ~a$~Rce. &. Agnea ~tence ...................... (owner, le~l) o~ the aforesaid building. , Suffolk County Department of Health Approval ~ ~ ~ ' Building Inspector FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. OERTIFI[IATE OF DI]P, UPANBY No..Z- 28~ .... Date ............. 0etobe~...~...., 19.67. THIS CERTIFIES that the building located at .. Ig/D. (3~0). Oak. ~ ....... Street Map ~e~a .I~e~g~ck ~o ............. Lot No. 18. ~ .19...Cu*ehog~,t, .[q',~.~... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......... Sept...lP.. , 19.6~. ~ursuant to which Building Permit No..362~ .~ dated ........... 8cpi .... 1~.., 19.6~, was issued, and conforms to all of the require- ments of the applicable provisions of the taw. The occupancy for which this certificate is issued is ... ~2~i~ate. ae. cesaOry, building. (~:hox,aga .et~.). .................... The certificate is issued to .~. ~ .~i~..~alla~e. Lat~e~o.e ........ 0~ ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health, Approval ..... ~.,~ ......................... Building Inspector / FOR~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N?. 3626 Z Permission is h~reby granted to: ..... ~,. ~ ~ ............ .................... ~eheg~e ...................................... to -"~=~t,"'a~x "~I~,~'~"'~"~c~r "b~f.~*~tt~g* ........................................................ of premises located at .... ~.~'~....~.....~ ~,~ ............................. ............................... · ~(~.*.-~..6.+~ ......... ~o~e¥...~.,.?~*, .............................................. : ........... pursuan¢ to application dated ............................... ~1;.....~[.~ ......... , 19...~, and approved by the Building Inspector. ~ ~e $.~ ............. ~ · ! '~ Building Inspector FORM NO. 1 I~)WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............................. :.~ ......... , 19..~..!... Permit No...~....~..~.....~....~ App eot on ......... Disapproved a/c ...]......:,,..~ ....................................................................... (Building Insp~ APPLICATION FOR BUILDING PERMIT Date ........... ~...../...~.~ ............... , 19..~.']~.. ..... INSTRUCTIONS o. 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 pa.rt 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 shal be kept on the premises avai ab e 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. APPLICA~TION 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. ka~nurure Of pp 'c , o ame, it a corporationi / (¢ .................................. .......................... ................. ........ ~'~ ~) (Address of ~pp ic~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................................................... .......... ............ ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No.: ..................................... Lot No.: ..../.../..~.. .......... Street and Number ....~..~...O....~..~..(.~.. ...... ~.[~Z ................................................................... ] ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy H O ~ ~ b. Intended use and occupancy ............................... 7 ............................................................................................. 3. Natbre of work (check which applicable): New Building .... ~ ...... Addition .................. Alteration Replir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Esfi~nated Cost ....... ~.~ ................................ Fee S (to be paid on filing this application) 5. If ctwelling, number of dwelling units ............................ Number of dwelling units on each floor if gbroge, number of cars 6. If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dir~e. nsions of existing structures, if any: Front ............................ Rear ................................ Depth H~i~lht ........................ Number of Stories ...................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear Dap[th ................................ Height ............................ Nurnber of Stories ................................ 8. Dimensions of entire new construction: Front ............ /....O.. ................. Rear ............................ Depth .... Heibht ...... I~..~ .......... Number of Stories 9. Siz~ of lot: Front ........... .b..'~...~..~ ........ Rear ......... ..~..'~..~..~. ............... Depth ...... .I....~....O.....~ 10. Dat~ of Purchase ..... ~...~ ........................ Name of Former Owner 1 1. ZoJe or use district in which premises are situated 12. Doe:s proposed construction violate any zo?ing law, ordinance or regulation? ........................ 13. Na~e of Owner of premises ,~..~..Z...L~..c.~...A,~.~.~..~..~.Address-~..~...~....~...~..~.'Z..~ N, No'ne of Architect ...................................................... Address ............................................ Phone No. Na~e of Contractor .................................................... Address ............................................ Phone No. I_ocat property I whether in PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nes. Give.~t. ce~t ~ block nj~rg,ber or, description according to deed and show street names and ;erior or ~co~'~er J6t. ~-~-~/~ STATE al NEW("~rO~,, ,~ ~ '~ S S COUNTY,OF ..',,~"~../~.~ ....... .f '~___~ ................ i ............ '/"~'"~:'":"~ ........... being duly sworn, deposes and says that he is the applic :(Name of in i~idual signing application) abow~ narped.~He is the ........ I (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 this application; that all statements contained in this application are true to the best of his knowledge and belieF; that the .w, ork will be performed in the manner set forth in the application filed therewith. Sworn to I:iefore me this ................ .......... ......... .... .......... Notary Public,/A/~'~.~i~,~... Cou~_~ // (Signature o~applicant) .~. ~o. 52-0618]00 Suf/olk Count~ ,~ommlsslon Expires March 30,