The URL can be used to link to this page

Home My WebLink About2508-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE E)F IDI3CUPANBY No. ;~ 2~6~ Date Dee 2-0 , 19 ~ THIS CERTIFIES that the building located at E/t~t t~l'bo:r I~n~ Street Map No. ;K~ Block No. 3¢X Lot No. Xxcc Cut,ehogue .N,~o ........ conforms substantially to the Applicabon for Building Permit heretofore filed in this office dated Sepl '3.' , 19 6~+ pursuant to which Building Permit No. 2508~ . dated Sept, 1 , 19 6t+, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is l~i'ta~;e o~e. family. <l',~e]L.~{i.~g ............................ The certificate is issued to ~l;exa.~der- ]Bogall. & .~/i~e -- O~e~, .............. (owner, lessee or {~enant) of the aforesaid building. Suffolk County Department of Health Approval Dec~, 6 1967,..by. R, .Villa. ........... ~uildi;~' i;;~;;t'o;''''f ....... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2508 z Permission is hereby granted to: to ...... 3~.1c1.. ae~ .. a~e ..£ead...~. ~e ;[.Z.~ ................................................................................ ct premises located at ...,~.....]~1~]130~'...][~,~11t..J[~gl~ll~J. He;~.~;~l;~ll.~ .................................... pursuant to application dated ............................ I~]p~i~l~...],. ...... 19.~i~,., and approved by the Building Inspector Fee $....10.*.00 ....... Budding Inspector $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Giv~ deed locat%/on) have been inspected by this department and found to be satisfactory. District Engineer FOF~ ~0. I Examined ....~o...! .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. (BuildiT/~ Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildi Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and gwmg a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatk c. The work covered by this application 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. 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 in whole or m part For any purpose whatever until a Certificate of Occupar shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describ The apphcant agrees to comply with all applicable lows, ordinances, building code and regulations. ~tone Chituk (Signature of applicant, or nome, if o corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buil .................................................... g.Q.~.~.~mt.Q~ .............................................................................................................. Name of owner of premises ..... ~,~,~,~bTt~.~]~,,~O~J~D,,.~;..I//,ll,;(',~ .................................................................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) 1. Location of land on which proposed work will be done. Map No ...... ~ ............................. Lot No: ..~ .... Street and Number ..._~. _~_~Q:~.,_~'te....(l~t~l~.e,t~..~tl:;,~) ....... C.~¢,~:~L1.e, ...................................................... Municipality 2. State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ....... .~...8:.O...~..~..~....~...Srtg...~.. ......................................................................................... b. Intended use and occupancy ......... .0...~..e.....~...~....~..1.~'.....~..~...~..]:...1..~..~.~ ................................................................. 3 Nature of work (check which applicable). New Building ...~.. Addition .................. Alteration ................. Repair .................... Removal .................... Demohtion .................... Other Work (Describe) ..................................... 4. Est,mated Cost ....... ~..6..,..0...0..0.....~../..~. ............................. Fee ........ .]:..9. ............................................................................ (to be paid on filing th~s apphcation) 5. If dwelling, number of dwelling units ...Q~e. .................. Number of dwelling units on each floor ........................... If garage, number of cars ........ ..t:.t~g ........................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................... 7. D~mensions of existing structures, if any: Front .......................... Rear .......................... Depth ........................... Height ............................ Number of Stories .............................................................................................................. D~mensions of same structure with alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..... ~.~..-..;~ ............. Rear ..... .~..~...'..~ .............. Depth ....;~..bc./....~...O. ........ Height ............................ Number of Stories ........ f)~e ............. 9. Size of lot: Front ........ ~..0.. ............... Rear ......... ~..~. ............... Depth ........ ~..~. ................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 11. Zone or use district in which prem,ses are situated ...... ~.~..~./.'....~.$..~. ...................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....................... ~..O. ........................ 13. Name of Owner of premises ..~,.~..~..o.~.~.,.~...~.....Address c)...O~......~..e...~..~...q.~.~...?~.....~....~...°~n~eeNo.~/'~.-..~.¢~.~ Name of Architect ..............~'~..~1'.Q~ID~ ................... Address ......~f~D~.t~f~ ................Phone No ................... Name of Contractor .... ,~',L~D~e...0.:~,~.t~ ................ Address ........... g.l~.~.~.l~g~. ........... Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro, property lines. Give street and block numbers or description according to deed, and show street names and ind~cat whether interior or corner lot. STATE OF N.E~. YORK, COUNTY OF ..:1,1~f~.~ .............. t S.S. ............................. ...~....~.o..~..e....~.~..~]~., ..................................... being duly sworn, deposes and says that he is the applica (Name of individual signing application) above named. He is the ................ ~OZ~t;Z'.~,~.t,O::L'. ............................................................................................................. (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 f th~s application, that all statements contained in this application are true to the best of h~s knowledge and bell and that the work wdl be performed in the manner set forth in the apphcat~on filed therewith. Sworn to before methis,-- ~ · __ __b~ .................. ..~...__day of ......... ~..~..t,.~9.e.~ ............. , 19.~. ..... Notary Pubhc-....~'~.~,.....~,:.~~..?:..,.'~Count~:'~-'~''' (Signature ~"~pii~'~'~¥i ~ ..... 50, .~-=--,T:,~ ' ' - I x~F1LL~x ._,LMENT oC ,%. L_LA~/¥OUN D,A,, T" lob4' NEW,. S-Z~'~.~ ~.~ gms ALEX~,MDE~. WILLIAM KEEN JOHHKE~ A.I.A, '1- LIVING BED 4 ,¢ -MAIh. I FLOOP_ PLAN° fill h L .... ,I