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Home My WebLink About3430-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E:E~TIFIP. ATE E]F OI-:.P. UPANP. Y No.~ 27~2 Date . -~ "%9' ', 19 67 THIS CERTIFIES that ihe building located at ~-~, ~l)~l~/$ ~ ~o~ ~ree/ Map No. ~ Block No ~ Lot No. ~ ~t~t~ -~. ........ conforms substantially to ihe Application for Building Permit heretofore filed in this office dated ApF~. %~ , 196~.. pursuant to which Building Permit No. 3~0 ~' dated ~t~ %2 , 196~ , was issued, and conforms to all of the require- ments of the applicable prowsions of the law. The occupancy for which this certificate is issued is acee~s~ b~d~.-..p~y. ~om. & .sleep~$ ~~$ ~. - ... The certificate is issued to B ,R,~e%h ...... ~em ......................... (owner, lessee or ten,t) of the aforesmd building. Suffolk County Department of Health Approval N,R, ..................... ~OTEI %'~le b~di~,g ~o ,,~, h'~:~e an~ c<,:kfng facilities o~ ~qui~ment, t .......... FORM 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) 3430 Z Permission is hereby granted to: ................. .~a..~3,~...~ .......................... to ...a.~.~.l~...~.~..~.-3r...b.~ld~t~l ....... ......... ~..~,..~...~.~.~ .......................................................................................... at premises I~ated at ..~..~.,~...~..~.~ ........................................................... .......................................... ~k~..~.~. ................................................................................. pursuam to application dated ~h ~ 19~, and approv~ by the Building Inspector. ~ Fee $ .~'~.(JO. ............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ]9 ........ Permit No ................................. D~sapproved o/c .................................... ~ ............ ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This opplicahon 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 gwing a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatio, c The work covered by th~s application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding Inspector will issue o Building Permit to the applicant permit shall be kept on the premises available for ~nspection throughout the progress of the work. e No budding shall be occupied or used in whole or ~n part For any purpose whatever until o Certificate of Occupant shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to tl Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances . Regulations, for the construction of buddings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply w~th all applicable laws, ordinances, budding code and regulations. (Signature of apphcant, or name, if a corporation) Camp Mineola Rd Mattituck (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildr o~gne z' Name of owner of premises ....M...r.~..,....E..:..R..:.~g.W.~.~h. .......................................................................................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer} 1. Location of land on which proposed work will be done. Mop No ...... .C..~,~,P....~.~,La...e..q~,f~ ......... Lot No' . ................ Street and Number ..... D..v..~...:~....~/.~q....Q.a:~p...~.t;irkCP.~,...~cl,, ..... ~.~a~.~:i.~.~ ........... 2 .................................... Municipality 2. State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction: o Existing use and occupancy ..... .a..o...oe..s..s..o..r.y....b...]..d.g ....................................................................................... b Intended use and occupancy . .. 3 Nature of work (check whfch applicable): New Budding .................. Addmon ...... ~ .... Alteration .......~... ..... Repair .................... Removal .................... Demohtion .................... Other Work (Describe) .................................... st,moted Cost ...... .................................... .............................................................................. / (to be paid on filing this apphcation) 5. If dwelhng, number of dwelling umts ........ .~...o..~..e.. .......... Number of dwelling umts on each floor .......................... If garage, number of cars .......................................................................................................................................... 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D,mens~ons of ex~sting structures, if any: Front ..~.~. ................... Rear ........ ~ ............. Depth ...20. .................. Height .......................... Number of Stones ...O.~...~..J;;.Q:~. .................................................................................... Dimensions of same structure with alterations or additions: Front .......... ~.~. ................. Rear ...... ;18...~..~.~. ...... Depth ....... ~.~. .................. Height .............................. Number of Stories ..Q~ ............................... 8 D~mensions of entire new construction: Front ...~8 .................... Rear .......... .1...8. ............. Depth ....... .~.~'~...~..6..¢ Height ............................ Number of Stories ...D~¢ .................. 9. S~ze of lot Front ............................ Rear ............................ Depth ................................ 10 Date of Purchase ..... &.c).~ ......................................... Name of Former Owner ...................................................... 11. Zone or use district m which premises are s~tuoted ...... !!&~]...~l.J.,s.~ ...................................................................... 12. Does proposed construction wolate any zoning law, ordinance or regulation? ........ ~ ...................................... 13. Name of Owner of premises .... .~.s.....~..:..~..~.~.q~.fk~..Address ........... ~'~'3.J~.t,~.~zzc~ ........... Phone No ................... Name of Architect ..................................................... Address ............................................ Phone No .................. Name of Contractor ..~.:...?..e..~?.~.o...s..~.~. ..................... Address ........... .~.~.~..~.l;.:~.~f~ ........... Phone No ................... PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro, property hnes. Give street and block numbers or description according to deed, and show street names and md~ca~ whether ~nterior or corner lot. STATE OF NEW~YQI~K~ 1 COUNTY OF ...~.z...zh.L.-~.. ............. f S S. .............................. .~:!.Z'...S..,....~..,.~.,,~p.~.fl.t3't .............................. being duly sworn, deposes and says that~-"he is the applic~ (Name of ,nd~vidual signing apphcation) above named.5¥te ~s the ....... Q~q.~..~£...pz'~lz~$e.s ..................................................................................................... (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 , th~s apphcation; that all statements contained m this application are true to the best of his knowledge and beh and that the work w~ll be performed in the manner set forth ~n the application filed therewith. Sworn to before me this ~-~ I ~. · .... ~,.~.. ............ day of ....?.~.~._/~ ................. , 19.~..?.. ~.,~,. *1 i~,---. /r~,,~.,., ,~ ~.~ .......... "'~:.'. ~.9 ...... 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