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Home My WebLink About2573-zFORI~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~'OWN CLBIiK'S OFFICE SOUTHOLD, N. Y. P. ERTIFIP. ATE I-IF i-IP.P. UPANP. y No. Z ~ Date ~oYe~'be~ 1~ 19..67. THiS CERTIFIES that the building located at ~.~. ~.~!~.~..~ Street Map No. ~ ....... Block No ...... ~... Lot No. ~ ~thol~ 1~I, conforms substanti~ly to the Application for Building Permit heretofore fried in this office dated ............ ~... !..., 19.~ pursuant to whia Building Permit No..~. ~ ments ,oi the applicable provisions of the law. The occupancy ior which th~ ce~fficate is issued is ~i~a~e one f~!~ly twell~g The certificate is issued to ~be~t ~e~ ~ (owner, lessee or tenant) of the Moresaid building. Suffolk County Department of Health Approval ~O~ ~ ~ b~ R~ ~ FORIFg NO. 2 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? 2573 z Permission is hereby granted to: .... ~ct~a~ :I;...Cz'.~ ~ e~ ............................................ ........... ~.....aht~e.h..~t .................................. to .... l~i,],cl..r~w.. ~ne. · £amt, .;I~F.. 4w®~. ti. rig .................................................................................. ct premises located at ...... ~l~.tOXl..~{O~k&..NO~.f~h~.~j~Cl...L~ .................................................... ........................................................ ~.o~.;~.~ .................................................................................... pursuant to applicatibn dated ............................ ][[OV~a~.....~ ...... 19.~.., and approved by the Budding Inspector Fee $.-]bO.O0 ......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~0V Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal ~cilities for a structure at ~/ (Give ~fe'"ed location) located have been inspected by this department and found to be satisfactory. District Engineer FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No .............................. Disapproved a/c ................. ~~.~~~ APPLICATION FOR BUILDING PERMIT Date ............................... 19./~, ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn on the diagram which is part of this application. 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. Such 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 in part ~or any purpose whatever until a Certificate 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 Southold, 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. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ......... aoher.t ,.~=.amer. ........................................................ (Signature of applicant, or name, if a corporation) ........... .1.1+1+. Church S.~, ~l..n~s .P. ark .. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................................... 0~e~. ................................................................................................................................... Name of owner of premises ....... ~D.'O~'.~...C:~.,%m?.,~ ..................................... If applicant is a corporaCe, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which pr~osed work will be done. Map No: ...... ~.~ .......................... Lot No: ..~ ........ Stre~ and Number ..... D.~.t.o~..~..~..~Q~.~.i~...~ ....... ~O~QI~ ........................................................ Municipality 2. State existing use and occupancy of premises and intended use a~d ~cupancy of proposed construction: a. Existing use and ~cupancy ....~fl.~..~ .................................................................... b. Intended use and occupancy ..... Q~..[.~..~.e.~li~ .............................................................................. 3. Nature of work (check which applicable): New Building ...,~21~.. Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost .... . ............. Fee (to be paid on filing this application) ...gl ...................... Number of dwelling units on each floor 5. If dwelling, number of dwelling units ne ............................ If garage, number of cars .............. ~...g.~. ................................................................................................................. 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 ............. ~.~ .......... Rear ....... ~..~. ............... Depth -.~:~/.....~.~. .......... Height ............................ Number of Stories .~.~. ..................... 10. Date of Purchase ......... ~.c~6.br. ..................................... Name of Former Owner ....... ?..t..~..*.....~...B' .~....e. ......................... 1 1. Zone or use district in which premises are situated ...... ~......C1.18.~. ......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~¢~ ..................................... Name of Contractor ...... ~¢~e:~ ................................... Address .....~,~,~..~..~.]~ ............... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, COUNT( OF ...~'n~£~11r ........... ~ S.S. .................... 2~).13~'.~..C~'~ ......................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application} above named. He is the ............... ~¢~e~....-....bu4.Zctez'. ..................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this applicat on; that all statements contained in this a.ppll.cation_are t.m.e .to t,h.e, bes. t of ..h. is knowledge and belief; and that the work will be performed in the manner set tortl~ in the application fired therewith. ......... ~o.~.eml~e~.., 19 .~, .................... ' _ ...... _ .... ........ ................ Notary Pubhc, ~l~... County~ (S,gnature of applicant) No. 5g-061~100 Suflolk Coun~t'// ~ommi$~ion Expires March ':~'0, 19..~_L~