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Home My WebLink About3401-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E:ERTIFIP. ATE: t-IF' I-II-:.r':.UPANP. y No. Z 2~t~ Date ...... ~r 12 ,, 19 6~? THIS CERTIFIES that the building located at 8~'~ (~'~ l)z~;I.~ Street Map No. Capt ]~¢!~1ock No. .. Lot No. ~I~1~ t~;~.:~.~..ll;! .~.~Y.~ ..... conforms substantmlly to the Application for Building Permit heretofore filed in this office dated · l~a~'ch .. '10 , 19 ~ pursuant to which Building Permit No. -~l+0~l..l& dated l~'eh ~1~ 19 (~, was ~ssued, 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 O~le. fe~.~ .~t1~e~ .~:~g .................................. The certificate is issued to .~.'1~¢~]¢.V ~.~ar~i~ ......... ~rie~ ................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~'Une ~ '1.~. b~' R~..~:~i&. FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ('rillS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3401 Z Permission is hereby granted to: ...~.~.e~.p.~... A~.~....~.....N~......~..te-~t--t~s to ~.. ~.~l~...~.w...~ ...~.~3,x...~w~ 1~ ............................................................................ at premises located at 'lOt 'l~l~ O~.t r~!,8 l~g~, ........................................ .~4~r~'l.. ~.r~r~ .............. I~at.t~.tta~k .................................................... pursuan¢ to application doted ............................... ..~...~.....,~.0. ....... , 19..~.~...., end approved by the Building Inspector. Fee ........... Building Inspector / S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~Z~7 Bldg. Permit No. ~ C'~/ Z TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. District Engineer District Engineer FOP~IV~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........ l ~ 19 ........ Permit Mo ~i~ ~ ~ (~uddm~ Ins~ctor) APPLICATION FOR BUILDING PERI, IT Date ... .~...~.?..~..~.....]:? ...................... , 19....~.? ....... INSTRUCTIONS a This application must be completely filled in by typewriter or ~n mk and submitted in duplicate to the Buildm Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adloming premmes or pubhc streets areas, and giving a detailed descnpt~on of layout of property must be drawn on the diagram which is part of this apphcat~o~ c. The work covered by th~s application may not be commenced before ~ssuance of Building Pe~rm.? d Upon approval of th~s appl~cation, the Building Inspector wdl ~ssue a Building Permit to the applicant. Suc permit shall be kept on the premises available for ~nspect~on throughout the progress of the work e No budding shall be occupied or used ~n whole or in pa rt for any purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Perm,t pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances ¢ Regulations, for the construction of buildings, add*t~ons or alterations, or for removal or demolition, as hereto describe, The apphcant agrees to comply w~th all apphcable laws, ordinances_and regulations (S~gnature of a~Jlcant, or name, ~f a corporation) 88-L~5 ~9th Ave, Brooklyu ~4, ~.Y. (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu~lde Name of owner of prem,ses .... .A....D:.t...h.o..lg..y..To~.l...a.t't.t,..i..~ ................................................................................. If aRphcant ,s a corporate/~,ignature of duly aut, b, orized off,cer ............. L/ [ (Name and t,tle of cg'torate officer) t67~ I Locot,on of land on which proposed work w,I1 be done Map__Nc°apt': 'F2LSd'"E§'~,~/~'§ ....... Lot No .1.5.~ Street and Number .......................................................................... .M...a...t...1..t..u...q.k.. ........................ MunJc,pality 2 State ex~st,ng use and occupancy of premises and ~ ntended use and occupancy of proposed construct,on a Ex~sting use and occupancy .......................................................................................... b Intended use and occupancy .... .o..n..e.f.a.m..i...1,y....d.w.e:.l..1.i...u.g ............................................................ 3. Nature of work (check which applicable) New Budding ...XX .......... Addmon ............. AIterahon .~....~ ..... ~ .... Repair .................... Removal .................. Demolition ................. Other Work (Describe) ........................ 4 Estimated Cost .........~3,O~D0~IoO.0 ................ Fee ................................................ (to be pa~d on fihng this opphcahon) 5 If dwelling, number of dwelhng umts ~ ..~'~l.~.~y. . Number of dwelhng umts on each floor ............... If garage, number of cars ....... O.t'l~...O~' ...... 6 If business, commercial or m~xed occupancy, specify nature (:nd extent of each type of use .......................... 7. Dimensions of ex~stmg structures, ~f any Front Rear ................... Depth ........................... Height ......................Number of Stones ............................................................................. Dimensions of same structure w~th alterations or addmons Front ......................... Rear ... Depth .......................... Height .............................. Number of Stones ..................................... 8 Dimensions of ent, re new construct,on. Front ..~Z.t. ............... Rear ..... ~7' ............... Depth ..~.~..~ ................. Height .... .t..,5~ ............... Number of Stor~es ...................... .......... ~Q ........................... 9 Size of lot Front ...... 9.0.' ................. Rear ..90.? . Depth t0 Date of Purchase ..... ~.~P.~..~.~..~ ......... Name of Former Owner ...D~,~'13 .~l~.~.~,.t,.e~.t ~..tlo. ~. .... 11 Zone or use d~stnct in which premises are s~tuated 12 Does proposed construction wolate any zomng law, ordinance or regutat~on~ .......... 13 Name of Owner of premises . ..~.O.~t;L~,13.t,~L~, ... Address~BLt...~ tg.t,l'~..f3t,~B~k].~.TL. Phone No ................... Name of Architect ....................................... Address ................................... Phone No ............... Name of Contractor ..8..o.]r..~..e. PP.~ /L.~.a...O. qt ..[.~.~., Address.~.2...~.0...~ttD,~.~..~.W~ ..... Phone No.T~.~..-.9..-...2.0].( PLOT DIAGRAM Locate clearly and d~shnctly all buildings, whether ex~st~ng or proposed, and ~nd~cate all set-back d~mens~ons fron property hnes. G~ve street and block numbers or description according to deed, and show street names and ,nd~catc whether mter~or or~eerner lot. STATE OF NE~ cou 'r¥ OF .i s s ............... ~.Oh~l~..~O~],~.~p.~. ......................... being duly sworn, deposes and says that he ~s the applicant (Name of indmdual signing apphcahon) above named He is the Oorpol~ate off,ocr - P:ve$~de~l~ (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file this apphcat~on, that all statements canto,ned ~n th~s applicahon are true to the best of his knowledge and behef; and that the work wdl be performed m the manner set forth m the apphcahon filed therewith Sworn to bef~,~me this ..~~~ ,~'~-/4K--~r--~"~U~L~N KOUT~,AS /,/) NOTARy PUBLIC, State of New York ........ ~' .~,-'~ day of . . , 19 ~ ~' Ne. s~-7:~41 ~ - Suffolk Count,/ · ~mk~ ~,~r~ /~c~oh.~Ot.106~ .................................................