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Home My WebLink About3640-zFORM 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. OEi~TIPIOATI= QP OOr. UI~ANO¥ i~I1HIS CERTIFIES that the building located at .~/.~....I~..~..0...~..O..0.~..?.~. ....... Street ~el Park ~ ~o ............. ~,o~k No ............. ~o~ ~o ....... ~ ~... &~. ~.~ ....... coniorms substantially ~o the Applicati~on for Building Permit hereto~o,re filed in this office dated ~0p~ ~ 19 6~ pursuant to which Building Permit No. 36~0 dated ......................... 8ep~ ~6 , 19. ~, was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .o,ccupancy for which this certificate is Private one family ~welling issued is .................... ~i~h '~;-'~'~'~ ¥..._____ ..... ~ .............................. The certificate is issued 4o ........................................................... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department. of Health Appzoval ......................................... Building Inspector FOP~M 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) 3640 Z Permission is hereby granted to: ..q~e.~.~...~.r?..~:[;.......~/..q ....~.~.& ....~...~ .i.~} to family dwelling at premises located at ..~,.~.t~..~,.,j...~.g~.~..~..~,~.~ ............................. [ .............................................. ......................................... ~/.e....~..o..,.~....u.~..o.~...~ .......... ~r~ .............................................. pursuc~ to application dated .................................. .~...e.~..~. ....... ?...6....., 19.....6.?., and approved by the Building Inspector. .Fee $...]..~..'. ~.~. .......... FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved t, ~k 19(~. Permit No. Disapproved ~~~ ....... APPLICATION FOR BUILDIHG PERMIT Application N o. *.~....~....?. ~ ............. 26 D. ~e~em~er 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 adjoining premi.ses 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. Eugene Hortozl (Signature of applicant, or name, if a corporation) New Suffolk (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................... .(~.O~ ~'.a ~..o.r .................................................................................................................. Nome of owner of premises ....~...~..~.~.~...~..~.~..~.,~.~.~ ................................................................................................................. If applicant is o 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.: Laurel Park Lot No.: LF1 Street and Number ....~/.~......!~..o...z:~...0..~?~.o...o..c3:...?.?.. ......... ~:~.~.e..3;. ...................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ~acant land b. Intended use and occupancy ...... ~.e.~?...o.~.e....~]~.$.~.....~.~.?.e.~:.Z. in~ ........................................ 7. Din Hei Din De 8. Din Hei 9. Siz~ I0. Dot Nat re of work (check which applicable): New Building .................. Addition .................. Alteration Repj~ir .................. Removal .................. Demolition .................. Other Work (Describe) Esti~nated Cost .... .1...8..~.~.0...0. ......................................... Fee ....~..0..~, (to be paid on filing this application) If dwelling, number of dwelling units .....o...n..e. ................. Number of dwelling units on each floor If c~arage, number of cars If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ~ensions of existing structures, if any: Front ............................ Rear ................................ Depth ht ........................ Number of Stories ensigns of same structure with alterations or additions: Front .................................... Rear th ................................ Height ............................ Number of Stories ................................ ~ensions of entire new construction: Front ....... 2.~ ......................... Rear ..... ~.~ ................... Depth ...... ~,.LI: ........ ;iht .................... Number of Stories .............o...~..e., of lot: Front .....~.0 ................... Rear ..... .~.Q .......................... Depth ........ 280 ................. of Purchase ........................................................ Name of Former Owner 11, 12~ 13. property lines. Give street and block number whether i'n',terior or corner lot. ' I'A" dist Zorje or use district in which premises are situated Do? proposed construction violate any zoning law, ordinance or regulation? ......... ~'~P. ..................... Na~e of Owner of premises .?'.~..]:~..~...~.e.?..~.J:..3z..]: ........ Address ......]:...a:.~..z..'..e..Z.. ........................ Phone No. Na~ne of Architect ................................................. Address ............................................ Phone No. Na~ne of Contractor .~..q~'.e..~.z.e....i.-.Z.o...z.'~..o...g.. ................... Address .....~.,e.~...~.?::.~.'~.o..1...~. ............ Phone No. PLOT DIAGRAM Loca~e clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fi or description according to deed, and show street names and indic STATE OI NEW~YQRK,.~ } ~ o COUNTY OF ...p..~..z..z...o.'..&..~. ............ j-a.a. ........................................... ~.~..~.e...~..e...~-.[.°.Z.tg..9..~. ...................... being duly sworn, deposes and says that he is the applk (Name of individual signing application) above na~ ~ed. He is the .................................. C~.t;.z:a~. g~.g' ........................................... (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 application; that all statements contained in this application are true to the best of his knowledge and belief; that the Work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ' 26 ~ ~ Sept ~ 67 ............... i ....... ~I ........ ~ ...... "~:"'"';Z~ ............... ' .......... NotaryPqblic~/~....~......(~<~;~unty (Signature of applicant) , NOTARY PUBLI,~, ,,taLe of New Yerk ~ No. 52~3233120 Suffolk Coun~ Term Expires ~arcl] 30, 19~