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Home My WebLink About2828-zFORi~I i~0. 4 TOWN OF SOUTHOLD BUILDING DEPAi~TMENT 'I'OWH CLERK'S OFFICE SOUTHOLD, N. Y. E~EF~TIF'IOATE OF' 1:3OE~UPAN~Y No. , .~...~.~.~.4... Date ........ ~..O.~..O..m~..~..~..~.,~ .......... 19. ~ THIS CERTIFIES that the building located at ~$~X~. ,~0~.h~. ......... Street Map N~~i~i~ Pa~ock No. ~ Lot No. 2~ SO~Old, ~,Y. conforms substantially to the App]icati, on for Building Permit heretoSo~e fried in this office dated ........... ~g. ~..., 19.~.5 pursuant to whi~ Building Permit No. ~.~ .Z.. dated ........... ~.~.2 ..... 19..~ was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy ~or which this certificate is issued is .......... 0~'. ~..~ .~-~ ...................................... The certificate is issued ~o ..... ~$~.~y. ~t~?~ .................................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ..... ~ .~.~. ~.~66. ............. Building Ins~or ' FOEi~ NO. 2 TOWN OF sOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (TH S ,PERM T MUST BI~ KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AuTHoRIZED) N?-2828 z Permission is hereby granted to: pursuant foai~j~lJ~ation dated ....... ; ....................... ;,.A~j~,~La ........ .,.~ 19.~:, and 'approved by the Building InspectOr S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date November 2~, 1966 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at w/s Willow Pond Lane, (Give deed location) have been inspected by this department and found to be satisfactory. Builder -Wm. B. Smith O~er - Leroy S. Ostroskl District Engineer District Engine~ ...... FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........... ~.~y..~......., 1 ¢)...~..~.-'- Approved ........................................ , 19 ........ Permit No ................................. D sapproved ................ Application No....~....~......~'.....~....~'.. APPLICATION FOR BUILDING PERMIT .................................. .................. ,19 Date - - ............ 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 for 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, J?uilding code ..... (AddreSs of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... D ............... Name of owner of premises ........ .~....~.....~. ~......~..~.. .............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: .~..~ .~... ...~'.....~'.. Lot No: .....~......~. ...... Stre~ and Number ............................................................... ~ ...... ~. ................................................................ Municipality 2. Stateex~st~nguseand~ccupancy~misesan¢tendeduse~nd~ccupancy~fpr~p~sedc~nstructi~n: a. Existing use and occupancy ............. ~.~. ...................................................................................................... b. intended use and occupancy .......................... /' 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Rep¢ir .................... emoval .................... Demolition .................... Other Work (Describe) 4. Estimated Cost ............... ..~... ...................... Fee .~.o (to be paid on filing this application) 5. If d~velling, number of dwelling units ........ 1 ................. Number of dwelling units on each floor ........................ If g~roge, number of cars .............../.. ...................................................................................... ' .............................. 6. If lusiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ L 7. Dim.~.nsions of existing structures, Jf 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 ............................ Numbe~ of Stories ............................ 9. Siz.eiof lot: Front .../...~..~......,~ ...... ~ar ....../....'~...h[..,.~ ........ Depth ..../..~" ~ .......... 10. Dat~, of Purchase .............~'./,A,.~../.~...~ .............. Name of Forme~"~;~';".~./..22/.~..g~'/......~......,.~..,.,/~.../....~.. 11. Zon~e or use district in which premises are situated ........ ~.. 12,, Does proposed construction violate any zoning law, ordinance or regulation? ...~...~. 13. Name of Owner of premise .~ . dress~f'.~...~..-~..~.... . . Phone N ...?....~.~.! ? ' - ' Na e of Architect ...... .-r .............................................. Address ............................ , ................ Phone No. Name of Contractor..~..~.../...Z./..,~.Z~.~....~../,¢'2.~.~...Address ...~.. ~.~.~) .................. Phone No~,.¢ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property li6es. Give street ond block numbers or description according to deed, and show street names and indic whether interior or corner lot. ' l STATE OF'NEW Y~ORI~,//, ,~,~ 1 ~. ,~",c, ~' ~/ ~.,.:.~ ben au sorn ............... t ...... :..~...~v..~.%/, ....... :.. ....... .....:... ,... , ........ g y w deposes and says that he is the (Name of indivi~al signing apphcabon) above na~ed. He is the ~ .......................... (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 t this application; that ail statements contained in this appiication are true to the best of his knowledge and beli, and that tee work will be performed in the manner set forth in the application filed therewith. Sworn to ~re me this - ......... ............. Note ry P~ 'i~~.~~..~..~o,n~~"~?~'~~~;~ ........................ ~f;