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Home My WebLink About8140-zFOF~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office $outhold, N. Y. No. 2~'3~. Date l Feb 2~. 19,77. THIS CERTIFIES that the building located at ./R/$. Na~. S~lolk. Ave... Street Map No..X~ ......... Block No. ~ ....... Lot No, ~..~a~titu~ ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... A~g...12.., 19..7~ pursuit to which Building Permit No. 8.1.~0g.. dated ............ Aug-. 42---, 19.7~., was issued, and conforms to ~1 of the require- ments of the applicable provisions of the law. The oceup~cy for which this certificate is issued is . .Pr[~ate. acee~.sory..storage .bu~ding .............................. The certificate is issued to ...~illard. & .~ar~Lou...~o~thr.~dge .... ~er~ ........ (owner, lessee or ten,t) of the aforesaid building. Suffolk County Department of Health Approval ~,E, ............................... UNDERWRITERS CERTIFICATE No...N ,}i, ...................................... HOUSE NUMBER .... 20~. ..... Street ... N~. $~olk. Ave ..................... Building lnspecto~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT "TOWN CLERK'S OFFICE SOUTH'OLD, Nr. 'Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: N~I.~L~..~&..&. ~.t~Lou.... 1~ o~.t;l~.t~l ge ........... .......... ~_-1;~ ............................................... at premises located at ..... ~..~.J~...JJ.I~...~t~.~'ID~.,A.~i~J ......................................................................... ........................................................................ · l~.t~ t;.~.i~e~ · · · · ~., .Y. ~ .................................................... pursuant to application dated .................... ~i~j[.....-~.2 ................... , 19.~.~.., and approved by the Building Inspector. Fee $. ~,l~,~,gO .......... ; [ ~" Building"Tnspector ~k TOWN OF SOUTHOLI~/ / ~~ - '~ BUILDING DEPARTMEICT-.~ . -"~ ~ TOWN CLERK'S OFFICE .~ SOUTHOI.D, N.Y. ~ Application No ................................. Disapproved o/c ~~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Building~ Inspector, with 3 set~ of plans, accurate plot plan to scale. Fee according to schedule. b~ Plot plan showing location of lot and of buildings on p~emises, relationship ~o adjoining premises or public streets o~ areas, and giving a detailed description of layout ofprope~ must be drawn on t~e diagram which is pa~ of this applicatio~ c. The work c~ered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Bu Iding nspector will issue a Building Permit to the applicant. SuCh permit~ shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until ~ Ce~ificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southoid, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described.j The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in, buildings for n~essa~ inspections. (Signatur~ot applicant, ~me, it a-corpor~tion~ ..... .......... ~Addr s pp' State whether applicant is,owner, lessee, agent, architect, engineer, generai contractor, electrician, plumber or builder. 0 ................ .~ t~ ~ ................................................................................................................................................... Name of owner of premises ~t- m ~]Q~ ~b ¢ O ~-~ ~ ~ If epplicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Builder's License ~'qo .......... ~--.~ ...................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade% License No ............................................... ...~...~ Location of land on which propo~sed work will be do~e, Map No,: ........................ /~ ..... Lot No .....~ ............... Street and Number ..~.L,,~....~M~.q~.'..~'.~J.~'.. ...... Municipality State existing use and occupancy of prem' s and i t nded use and occupancy of proposed construction: o, ~xisitJng use and Occupancy ....................................... b. Intended use and occupancy .........................~.k. ............. ~.~-z.~....~....~ ..................................... 3. Nature of work (check which applicable): New Building..........~.. Addition ............. ..... Alteration ................. Repc, ir .................. Removoll)lC.%~..Jz. bC¢(. .... Demolitior ..................... Other Work ................................................... (Description) 4. Estimated Cost ............................................................ Fee (to be paid on filing this application) ~ If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of c~rs ............................................................................................................................................ ~ If business, commercial or mixed occupancy, specify nature and extent of~each type of use ............................ ,~ /~ / Dimensions of existing structures, if any: Front ..~7~; ......... Rear .......... ~ ......... Depth ...~ Height ........................ Number of Stories ........ ~.t~ ................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... [,~..~--~ ................ Rear ........ ~.~..,~'"~ ....... Depth ...,]~.~ ........ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........ .:..~ .................................... Rear ......................... Depth ............ 10. Date of Purchase ................................................ Name of Former O-' -wrier ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: .... J.~ ............................................... 13. Will lot be regraded . ........................... Will excess fill be removed from premises: ( ) Yes ( ) No 14. Name of Owner of premises .................................................... Addre~ ................................ Phone No ....................... Name of Architect .............................................................. Address ................................ Ph~e No ....................... Name of Contractor ............................................................ Address ................................ Phone No ....................... PLOT DIAG~M Locate clearly and distinctly all 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 iron, riot or corner lot. STATE OF NEW ?ORIf,l -- IS S COUNTY ~~~5~'''~ '~~ -- ~]~ L,~, .................... ~~...~.....~.~.~.~'.<.~,~ng duly sworn, deposes and says that he is the applicon, (Name of individual signing contract) above named. He is the ............... ~~~ ................................................................... ] .......................................................... (Contractor, agent, cat, rate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oil statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this .............. , ........ ......... ................... ~ ~'~'"'~,//~ fi' (Signeture ~. opplicant)~