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Home My WebLink About3659-zFORM no. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT '~'OW'N CI~ERK'S OFFICE SOUTHOLD, N. Y. No..~..29.9,11' .... Date .............. Fob ...... ~ ........ 1968. THIS CERTIFIES that the building located at .I~/$.. Mt~ld. le. ~Reatt. (Cl{2.7.A)Street NIap No... ,~gX ....... Block No...YL;~ ....... Lot No ........ ~Oll~;hol(1.~ · ~.,~. ........... conforms substantially to the Applicati,on for Building Permit heretof, ore filed in this office dated ........... 0~t; .....4~ .... 19.67 pursuant to which Building Permit No. -36~9Z · dated .......... 0¢.t; .....6 ..... , 19.6~., was issued, and conforms to all of the require- ments ,of the applicable provisions of the la~v. The ,o,ccupancy for which this certificate is issued is .. P.~.il/;ate..c, ll¢.,,· f&~;'l]:y, tt.~e~..~ing ......................................... The certificate is issued ~o ~.~;a~.Y..~O.~0O~0$~,t ......... 0.wlae~. ..................... (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval ......................................... ,,, ........... ~ Building Inspec;// FOK!YI 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? 3659 Z Permission is hereby granted to: to ~[.qP..~.~.e.....~...e.~,,t ~.t;.~.. ~w.~;L~ ..m~ .. l~,4...~m .. &~4~[~ ..~ .. ~ ............ at premises located at~..~..~l,~.~,.e...~:~&~.....~]~/.) ....................................................................... .......................................... s...o.~.t.~..,..~ .a. ....... .W :~.,. .................................................................................. pursuant to application dated ............................ .0..0...~..0..~.,,~.~'......~.. ........ , 10...~.~.., and approved by the Building Inspector. Fee $..~,1~1~.1~ .......... Examined ........................................ , 19 ........ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT ,,TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. 3 ~/'~'~ Approved ........................................ , 19 ......Permit No ........................ Disapproved a/~..~ ........................................ ................ ......g ............................ APPLICATION FOR BUILDING PERMIT Date ........................... .0e.to:be.~..-6 ........ , 19..67 ..... 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 tot 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 drown 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 avoi 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. 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, ar for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. . · .J,~'n~..~te, p c~¥, ~.c. ................................................................ (Signafure of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general rCOntractor, electrician, plumber or bailder. ................................................... C~n.¢,~'~c t c~r. ...................................................................................................................... Name of owner of premises ~.'I~/~t~.~,~/'...~.~D. OS!'[~ ........................................................................................................... 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 t~/~..~,¢t~],e...t~,o~c~...(.¢Z~2.) ........ ~o.~.¢.t~o~c~ ......... .t~.o.Y..0 ................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~/.~].].~?~. ............................................................................................................ b. Intended use and ~ccupancy~...~L.~..~..ft~t~(~..8~.fj~..~.~.`~.~.~.~...~D..~¢..~ ................... 4. 5. 6. 10. 11. 12. 13. ]_ocat property I whether in Nat;ute of work (check which applicable): New Building .................. Addition .3l, J¢,.~ ........ Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) '~0'~1~'"13~,'~3~'"~'0'"J Estil..ated Cost ...~'.feO~..~/~k[ .................................... Fee ...... ~0~,~.~AA paid on filing this application) If cJwelling, number of dwelling units ..... O~,e ................ Number of dwelling units on each floor If g'arage, number of cc~rs If Susiness, commercial or mixed occupancy, specify nature and extent of each type of use Din ~e'nsions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Din ensions of same structure with a.tterations or additions: Front .................................... Rear De[ th ................................ Height ............................ Number of Stories ................................ Din ~ensions of entire new construction: Front .......... ;ILk ..................... Rear ..... .'l.l+ .................. Depth .....1.1t. ......... Hei.ght .................... Number of Stories ........ Siz~ of lot: Front "~:ee~a;~e ......... Rear .................................... Depth ................................ Dat[e of Purchase ........................................................ Name of Former Owner Zorje or use distnct in which premises are situated ..... t~..I...(~.'L~.t~ Do,s/proposed construction violate any zoning law, ordinance or regulation? Narjne of Owner of premises :8~;~3r...JJe.]~)e~o~ddress .'....~(>'~.¢~o.lx.i ................... Phone No. No/me of Architect ...................................................... Address ............................................ Phone No. No,ne of Contractor ....~Teh~..~,3]3'~.~ ................... Address ...... ~.ffut~(>l.~l, ................... Phone No. PLOT DIAGRAM ; clearly end distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nas. Give street and block number or description according to deed, and show street names and indic :erior or corner lot. NEW Y ~ ............ s.s. STATE OI COUNTY ................ ; ............... 0'~.t'~.. ]'~,~ l~ ~p,..~ .................................... being (Name of individual signing application) abow,' named. He is the ................... .C[o~t,~,¢.'~,o~ ............ duly sworn, deposes and says that he is the appli( (Contractor, agent, corporate officer, etc.) of said ortner 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 ~ork will be performed in the manner set forth in the application filed therewith. Sworn to ~efore me this ' i ' NOTARY PUBLIC, State o~J~ew ! I~o. 52-3233120 Suf[okkl i Term Expires NLarch