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HomeMy WebLinkAbout3416-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. EI~TIFIP. ATE DF OOP. UPANP. Y No. 2; ;~891... Date . . THIS CERTIFIES that the building located at ~rivate l~c~d ... Street Map No. 3G~ Block No ZZX Lot No. XKK .... I~authold,~,Y, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated N~rch 30... , 19 67 pursuant to which Building Permit No. dated [~lar~h 31 . , 19 fi7 , was issued, and conforms to all of the require- ~r~nts of the applicable provisions of the law. The occupancy for which this certificate is issued is . a.dd[:l, tig)~ .tO..~rle. ;[e~lly..dwel]ki~g ............................ The certificate is issued to ~y .l~lttto~e. ~'~.tlsea~u .~,. Owr~e~c .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....~*~. ........................ FOEM NO. l 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? 3 16 Z Permission is hereby granted to: ......... Robt.. l~a.l.graf.f .. ........... iio~thetel ................................................. to at premises located at .J]/.S..~lr~..JJ,O.e~.,..~l//.J~..JJo~.~l%..J~i~t...jJd ........ ~ .............................. .............................................. · ~utho;IA,..... Ii. ~.. .................................................. ............................ pursuon¢ to opplicotion doted .................................. .[~i~Cl~......~,..., 19..67.., ond approved by the Building Inspector. Fee $.....~00~ .......... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ~ ~ ......................................... 19 ........ Permit No ............................ D~sapproved a/c .............................................................., ................................................ :.i..i..i... i;i .. . iiiiiiiiiiiiiiiiiiiii ........................ (Buddin/~ Inspector) APPLICATION FOR BUILDING PERMIT Date ...... .~...,~.. ?. ~ ....., .~.. ................................. , 19..,6.7.... INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets areas, and g~ving a detailed description of layout of propertymust be drawn on the d~agram which is part of this applicatio~ c. The work covered by th~s apphcatton 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. Suc permit shall be kept on the premises avadable for inspection throughout the progress of the work. e. No budding shall be occupied or used in whole or ~n part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Build,ng Department for the ~ssuance of a Budding Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulations, for the construction of buddings, additions or alterations, or f/o~emoval or demolition, as herein describe; The apphcant agrees to comply with all applicable laws, ordinances, b/u~Jdin)tJ code and regtjlations. J, [ ' ~')'*' t (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, Builder Name of owner of premises ...~[~......~,~.:k~t.O.~...~...Z:R..'.z..~..e..~.e...q .............................................................................................. If applicant is a corporate, s~gnature 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 575 Private Rosd Southold, N.Y. Municipality 2 State existing use and occupancy of premmes and intended use and occupancy of proposed construction: Private Residence o Ex~st~ng use end occupancy ................................................................................................................................. Private Residence >/ .-', :.'. ', b Intended use and occupancy ..................................................................... ; ........................................................ 3. Nature of work (check which applicable)' New Building .................. Addition ..~. ............... Alteration .................. Repmr .................... Removal .................... Demolition .................... Other Work (Describe) ...................... :. .............. 4. Est,mated Cost .......~....~..z~...0..0..."..0..©. .............................. Fee .......................................................................................... (to be paid on filing th~s application) 5 If dwelling, number of dwelling units ............. ..O.~..e. ....... Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................... specify nature and extent of each type of use ....... ~ ....................... 6. If business, commercial or mixed occupancy, , , ~ 7. D~mensions of existing structures, if any' Front ..... 5.2 ................ Rear . ..~.2,, ................. Depth ...~.~ .................... Height .... ~.~.! .................. Number of Stories ........... .0..ri.e.. ............................................................................................ D~mens]ons of same structure w~th alterations or additions Front ........ .~J~ ................. Rear ' · 6' 1 ' One DeD~h 3. ........................ He,ght ........ .~-. ................... Number of Stories ........................................ ' 12' 8 Dimensions of enbre new construct,on. Front ...~.t. ................... Rear ....?.~. ................... Depth ............................ Height ...... ~.?..'. .............. Number of Stories ...............O..~.e. ....... 9 S,ze of lot Front ....... .?.~.'. .............. Rear 75' Depth 2~' 10. Date of Purchase ...... ~..~D~.:...~..q.~..7 ........................... Name of Former Owner ..... .~.~.g..~...~:~...~...~....~.~..~..e.~ .......... Residenti al 11 Zone or use distr~ct m which premises are s~tuated ................................................................................................ 12 Does proposed construction violate.any zonm._q law. ordinance or reflulation? ....... ~.Q ......................................... 13 Name of Owner of premi~s~...~...~..~..°....z~..~.~.e...B..6.,~ddress ...~..°..~.~..~..°...1.~.L...~.....~..: ........ Phone No...?...o.~...?.~.~ Name of Architect ..................................................... Address ............................................ Phone No .................... Robert Hal'l~r~' ............................................ Phone No ................... Name of Contractor .................................................... Address Bo~¢~o'lcl.~ ~T.¥. ~0~ 21~? PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether exmtmg or proposed, and indicate all set-back d~mens~ons fron property lines. G~ve street and block numbers or description according to deed, and show street names and ind~cat, whether ~nterior or corner lot. ~ ~r ~A ~.~,~ }/ STATE OF NEW YORK, COUNTY OF ............................./ SS. Robert C. Mallgraf ............................................................................................... being duly sworn, deposes and says that he is the applican (Name of individual s~gmng applicatior~o~tr~otor above named. He is the ....................................................................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the sam work and to make and th,s aophcation; that all statements conta,ned in this a.pplication are trcj~to the best of his knowledge and behef and that the work will be performed in the manner set torth in the apvi~c~ion filed therewith. Sworn to ~e me this ..... ...... ....... . Notary i ......... ........................ ("/ t,'~c~ ef~ ~9¢e~ ·