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Home My WebLink About9053-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Buildin§ Inspector Town Hall Southold, N.Y. Cerli{icale O[ Occupancy No..Z.1.1.8.6..5 .......... Date .......... ?.u. g u. .s .%. .1. 6. ............ 19.8.3. second floop THIS CERTIFIES80that the building ,.. 'd ]' ~h' 'I~<3 ~ ~1 .................................. Location of Property .3. 0. ! .5 .............. B. a. ¥ y.i.e.¥..~.o.a.d. .................. .S .o.u.t:. h..o .1.d... House No. Street Ham/et County Tax Map No. ! 000 Section . . . 0 ? ~ ...... Block . . .q 2. .......... Lot .... 0..1.0 .......... Subdivision..~.e. ~..~..C.~. e..e.~..~, s..t.a.~.e.s. ........ Filed Map No..3.8. ~ .8...Lot No.. ! ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ·...F.e.b..~.u.a.~.7...2.3 ..... ,19.7.7. pursuant to which Building Permit No. 9053 Z dated ....F.e.b.q .u .a ?. y. . .2 .3 ............ 19 7.7., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... the second floor completion of an existing dwelling. The certificate is issued to .... ~.L.~.B.E.T.H.~ WILLIAM PATRICIA & JOAN QUIRK · ' ioh;.'o'r,'f~'dr-ei~'~'t) ...................... of the aforesaid building. Suffolk County Department of Health Approval N / A UNDERWRITERS CERTIFICATE NO .................................................. Rev. 1/81 .......... 9. ......... q.~. ............ Building Inspector 'rowN oF S~u~moLD BUILDING DEp,~RTMENT TOWN CLERK'S oFFICE SOUTHOLD, N.. Y. BUILDING PERi, IT (THIS PERMIT MUST BE KEPT ON THE PP, EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 9053 Z Permission is hereby granted to: Windswa~. Buildin~ Corp. 8outhold build addition (2nd Floor completion) on existing dwelling ~.ot 1 ~est Ck Est at premises located at ..................... ~ ........... : .......................................................................................... ........................................... ~.......t.~,~:.:.. ~9.~.~.....~..~..Z..e.m~..~.o.~ ............................. : ......................... Bouthold pursuant to application dated ......................~.~.Jl....2~ ................. , 19.~...., and approved by the Building Inspector. ........... Building Inspectfr 3. Nature of work (check which applicable): New BulJding,. ................. Addlfion ....~ .........,~lfere~on .....~...~. Repair .................. Removal .................. Demolitio~ .................... Other Work ................................................ ..., (Description) 4. Estimated Cost ......................... ?. ................................. Fee ....~..~.....0,.0. .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .o.b.e. ............. Number of dwelling units an each floor ............................ If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....~,.e..g.9..~.~..,.~...~..°.,,°.~.... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ........ ~.....~.:k~.¢. ............................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation: ......... T~.q .......................................... 13. Will lot be regraded' .......~...O. ................. Will excess fill be removed from premises: ( ) Yes ( ) No 14. Nome of Owner of premises .~J~t~¢~.s.~.a~...~u~3,6,t~...C~z~]~ddress ......... .~.~.o.~..~... Phone No ....................... Name of Architect .............................................................. Address ................................ Phone No Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. see filed plan STA~FE OF NEW ~ORK, COUNTY OF .... ~£Z'.Q]J~ ........... ~'~ .................. ~ob~..W~&.B.~. ............................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the ................................ ..°.W.z~?.?...-..b...~.J,.~..c~!~..z~..~....0..°.?..~...'q'[;'.:~'~'¢"~ ............................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, end is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and thai' the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this Notary Public, . ................... ~.~..+..~....W .................. ~ounty ..~ ........................................................................... (Signature of applicant)