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Home My WebLink About3423-zFORM NO. 4 TOWN OF 80UTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIP. ATE r'lF QCP. UPANCY No. Z 27.94.. Date ...... August 8. . , 19. [;.7 THIS CERTIFIES that the building located at Lupt:on .I~o..lnt: Street Map No ~ Block No ~ . Lot No. ~ ..... ita~tZ[tUC/k,,l~. It',. conforms substanttally to the Application for Budding Permtt heretofore filed in this office dated April .10 ....... , 19 67 pursuant to which Building Permit No.34~.3Z... dated Apl~ll 10 ..... , 19 6.7. , 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 ~.e £..amiil.y' . .d~.?.~.l.t.n.?. ?.t..~...~??.??.n.?d...~. ~..~. ........................... The certificate is issued to ..... R~l;~elc. t;. 8,. l~.a~.~ .o~er ..................... (owner, lessee or tenant) of the aforesmd building. Suffolk County Department of Health Approval ..... iE~K ................ FOE~I 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? 3423 Z Permission is hereby granted to: ....... A,,..~x..e....~.<~.....,~.....c....~...~..,~e~ at premises located at ...]:Jl~t,,DO .:J,~3.~9 ............................................................................................ ........................................... ~tt.~t~k~ ....... ~o¥., ............................................................................ pursuant to application dated ......................... .A.~.~,~.~. ....... .~...0. ........... , 19.67., and approved by the Building Inspector. FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Exam,ned ........~...l....O. .......... 19~..~.. Z. Approved ........................................ , !9 ........ Permit No ............. - Dlsapp roved a/c ........ ...............................~"~~i'~'~',i~i~ ............................ APPLICATION FOR BUILDING PERMIT Date .... .~.../...:. ............................................. , 19..~..~... / INSTRUCTIONS a. Th~s opphcation must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildir Inspector. b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets areas, and gw~ng o detailed description of layout of propertymust be drawn on the d,agram which is port of this applicotio c The work covered by this application may not be commenced before ~ssuance of Budding Permit. d. Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant. Su. permit shall be kept on the premises available for inspection throughout the progress of the work. e No building shall be occupied or used Jn whole or m part For any purpose whatever until a Certificate of Occupan shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Budding Permit pursuant to t Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buddings, add,hans or alterahons, or for removal or demolition, as herein describe The apphcant agrees to comply w~th all apphcable laws, ordinances, budding code and regulations. ...... .... a: ................................. ( ignarure~rt, pp ' , n , 'f corporation) (Address of applicant) State whether opphcont is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nome of owner of premises .~.....~..... ...... ~ ..................................................................................... If applicant ~s a corporate, signature of duly authorized officer. ..... ...... ......................... (Name and title a~f corporate officer) .... 1. Location of land on wh ch proposed worJ.k._~ be dope. Mop lxJo ........... Lot No: ............ Street and Number .............................................................................................................. Municipality 2. State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: o Ex,sting use and occupancy b Intended use and occupancY'.~.....~....~....~~.~.~.~.~..~.~.~.~...~.~.~.~.~.~..~...~- '~~"~"~~'"'"i! "'"'"'"'"'"'"'"'"'"'"'"'"'"'"'"'""""'"" 3. Nature of work (check which applicable): New Building .................. Addition ~'~ Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4. Est,mated Cost ....... ..~......~,.~...O......~..?. ...................... Fee ........ ~...:..~...?. ................................................................... (to be pa~d on filing this application) 5. if dwelhng, number of dwelling units ............................ Number of dwelling umts on each floor ........................... If garage, number of cars .......................................................................................................................................... 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7 D,mensions of ex,sting structures, ~f any: Front .......................... Rear .......................... Depth ........................... Height ............................ Number of Stories ............................................................................................................. D~mens~ons of same structure with alterations or additions' Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stones ........................................ 8. D~mens~ons of entire new construction: Front ...... .~..~ ................. Rear ............................ Depth .../...~. .................... Height ............................ Number of Stones .... /.. ..................... 9. S~ze of lot: Front ............................ Rear ........................... Depth ................................ 10. Dote of Purchase ........................................................ Name of Former Owner ...................................................... 11 Zone or use d~strict ~n which premises are s~tuated ................... '. ........................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation:~ .................................................... 13. Name of Owner of premises .~¥~...~R~.~ ....... Address ......??. :'.~.~.'~. .., .. ~...~. .. Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor .~/~..~-~r..~...~.~:q...~.~.~-, ....... Address~ ' O ...~/?:2.~-~....~...~.. Phone No..~.~....~...%.... PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fror property hnes Give street and block numbers or description according to deed, and show street names and red,cai whether interior or corner lot. STATE OF NEW YORK, cOUNTY OF ............................... / S S, ........ ..~.~~ .~, ..~~ ................................. being duly sworn, deposes and says that he is the app ..... '(~lame of individual signinglapphcat~on) above named. He ,s the ........................... ~K~.,~,,~ .................................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and this application, that all statements contained ,n this application are true to the best of his knowledge and bah and that the work w,II be performed in the manner set forth in the apphcation filed therewith. Sworn~to before me this ......... ............ o, ................. , ' ~. ''.qq,',~.~.zz~ ~'."~' '~ ~?" ~ ........................................................................................ Nota~ Pubhc,~.~~ounty ~~-'"'" ~ ~ (Signature of applicant)