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Home My WebLink About3664-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. rq. ERTIFIP. ATE OF E][3P. UPANBY No. Z' '29~) .... Date .......... Decel~e~'-..~ .... , 19,, ~ THIS CERTIFIES that the building located at . '~/8' ' 'Pi~ '8~ ........... Street Map No. .~... Block No... ~ ....... Lot No. ~ .... ~e~¢' ~ffo-~'k' · ~i .... conforms substantially to the Application for Building Permit heretofore filed in ihis office dated ......... 8e~- · - ~O' ' , ~9 6~' ~ursuant to which Building Permit No...~ dated .......... ~t .... ~0 .... , 19.09,., was i~sued, and conforms ~o all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is The certificate is issued' to .. 'V;l.!~"o~::~' ~ f~l~.~ ........ ()~ ~ .......... ............ (owner,~essee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ... ~.,R, ....... .................... Building Inspector FO~ NO. ~t 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) No. 3664 Z Permission is hereby granted to: et premises located at .JIJ~/-~....~,~.~..~J~ .......................................................................................... ..................................... ~i~.. ~t......~l..~. ............................................................................... pursucmi' to application dated .............................. .~.[ ............ ~. ....... , 19..~., and approw~l by th~ Building Inspector. Fee $.~0 .............. i "~" ' ........ l.~'.,~.:..:....~. ....... ; ......... .:/. .......................... Building Inspec~6r FOEM NO. 1 T~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .....~.~... ................ , App roved 19 ........ Permit No. Disapproved a/c ..... (Building ~spector) APPLICATION FOR BUILDING PERMIT Date ~X¢) 19~Z ..... 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 o 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 nat 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. .... //~ (Signature or applicant, or name, it a corporation) ........ (Address of appl~ant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........................................................................................... 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 ....... ./..~:.~.~.. .......... ~.....~z~...~.~...~.~.~ .~..~./.~/~.~..~`~../g../~..~'.~.~..~..~..//~..~./.~.~.~ ............................... Municipality 2. State existing use end occupancy of premises and intended use and occupancy of proposed construction; a. Existing use and occupancy ............... .~......~.~. .............................................................................. b. Intended use and occupancy /~) J4~ ~ Z ~- /.)// ~.. 3. Nat:ureJ of work (check which applicable): New Building .................. Addition ....... ~ Alteration Reppir .................. /~Removal .................. Demolitian .................. Of, her Work (Describe) 4. Est mated Cost ....... .~...E ............................................ Fee .............. .~...: ...... ', (to be paid on filing this application) 5. IF dwelling, number of dwelling units ......... ~ ............... Number of dwelling units on each floor ...~.~Z. ..... If g~rage, number of cars 6. If ~usiness, commercial or mixed occupancy, specify nature and extent of ~acb ~ype of use 7. Di4ensions of existing F~ructures, if any: Front ............................ Rear .....:-~..~..~_~ .......... Depth .....~.:~..:7..ff Height ~,~.'...~.?..MC.. Number of Stories .......... ...................................................... Dimensions of same structure with alterations or additions: Front.... ...... Dep:th ...... Z ........................ Height ~..~.~..: .......... Number ~f Stories .............. , ....... w ....... 8. Dimensions of ~nt~re ~ew construction: Front ...... .l..~.tv..~ ............ Rear ,...~..:..~. ........... Depth 9. Siz~ of lot: Front ..... ~&.:..~ ........ Rear ...... ~.~..2....~ ..........Depth ........ 10. Dat~ of Purchase ........................................................ Nome of Former Owner 1 1. Zon;e or use district in which premises are situated 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? .~..~. 13. Na~e of Owner of premises ~)~¢~~/~)~ddress~~ ~ ~¢Z ~¢~¢¢~ne No. Na~e of Architect ...................................................... Address ......; .................................... Phone No. Na~e of Contractor .... E.~.~.~ ........... Address ~(~..~ .... ~.~ Phone No. I PLOT DIAGRAM L.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lihes. Give street and block number or description according to deed, and show street names and whether in~erior or corner lot. ' _. , t~- STATE OF jNEW YORK, ] c c COUNTY 0F ................................ ~¢'~' ,, , p . ...................................................................... being duly sworn, deposes and (Name of individual signing appli~tio~) j nam, d He is the C'¢ ~ Z ~h 0 T a ~ above ~ ...................................................................... (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 applic6tion; that all statements contained i~ thi~ app,lication are true to ~he best of his knowledge and belief; that the wo'.rk will be performed in the manner set forth in the application filed therewith. Sworn to bS~ore me this ,~ ~ Notary Publ .... ~ ..... aunty (Signature of applicant) No 52 3222120 SU~[ol~ Go pi as March .qn ~a ~ says that he is the applicc