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Home My WebLink About2834-zi~ORM 1~O. 4 TOWN OF SOUTHOLD BUILDING DEPAETMENT TOWN CLERK'S OFFICE SOUTHOLD, N, I::IrRTIFIP. ATE: DF E]BEIUPANCY No. ~ .~ .... Date .......... J~o.v.e~he:~ .... 2~ .... 19.66 THIS CERTIFIES that the building located at .~/~1 .. ~0tall~. ~.~ ..... Street conforms suDstantially $o the Applicati,on for ~nil~ing Permit heretoeore filed in this office dated ........... ads ..... ~ .... ~s. 6~ ~u.rsuant to whi~ Building Permit No. a83b. a- dated ............ A~ .... ~ .... lm.6~ was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The ,occupancy f,or which this ce~ificate is issued is. P.~tvage..one 'f~ily' d~e~[ng .......................................... The certificate is issued ~o Fr~. ~$h~ ......... 0~. ........................ of the afore.said building. ,Suffolk County Department of Health Approval (owner, lessee or tenant) · .Set, i;...at. .196~. · .~y..R,..~tt.ta .... FORM 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? 2834 Z Permission is hereby granted to: ..3~.. ~J,~.s~,~ ............................................. ..... ~A~,~ ......... ~,~¢~..~t .................................... ............ ~o~1~:I.~ ~ ..... ~ ,,.~., ............................... to ....... tm.$.~6..-ne~., one .. t'~u~t.].~,..d~e'l'~.twg ................................................................................ at premises located at ..2,0~..~,~..t ........ ~1~"~]:d~"~-'~t~I ........................................................... ............................................. ~otu~..Be~eh...I~re ~ ............ ~,l~'b~;t~k ....................................... pursuant to application doted ............................... ~U~.. .............. .~ .... 19..(~., and approved by the Building Inspector Fee $..10,.00 ......... $CHD SUFFOLK COUNTY DEPAkT?ENT OF HEkLTH Datem, Building Permit No., 2,83~2 TO ~HOM IT ~Y CONCERN: The sewage disposal facilities for a structure located at ........ (Give deed location) Northside of Inlet Driver 100~ East ~ Ittlet Drive~ Captain Kidd Estates~ Mattttuck~ Town of Southold have been inspected by this Department and~found to be satisfactory. Distriot Engineer Di~{rict Engineer FOEM NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI. D, No Y. Disapproved a/c ...... ~t .............. ~.~ ................................ ................................ APPLICATION FOR BUILDING PERMIT 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 property must 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 thi~ 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, building code and regulations. (Signature of applicant, or name, if a corporation} (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... .......~n .~..e..~ ..................................................................................... Name of owner of premises ....... ~z'.~..~.~J,z:.~b-,%.°'. .................................................................................................................. 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. Ma~ No.: ..... ~ ........................... Lot No.: ...~ ................. Sm~br~c].~. o~ Sound_ Beach gri~e~ 90 Street and Number ...................................................................................................................... ~.~..~..E~ ........... Munici~lity State existing use and occupancy of premises and intended use and occupancy af prapas~ construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ................. ~,.~]~;~..?~'~..?~]'.~J'.~ ..................................................... 3. Nature ~f work (check which applicable): New Building ....... ~ ..... Addition .................. Alteration Repair J ................ Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimate'd Cost ........................... '~000~ ................ Fee .......................................................................................... ~ (to be paid on filing this application) 5. If dwell rig, number of dwelling units ...... ~ ............... Number of dwelling units on each floor ............................ . r ' n f f ga ag~, umber o cars .......... l~Ot"l~,' ......................................................................................................................... 6. If busir~ess, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dirnensi.'ons of existing structures, if any: Front ............................ Rear ................................ Depth .; .................. Height ~ ....................... Number of Stories ................................................................................................................. Dimensipns of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ........................~... ......... Rear ................. ~ ......Depth Height ........ ,1.~..1. ..... Number of Stories ......................... .1.....1~. ............................................... 9. Size of I~t: Front .................. ~.0.~.... Rear .......... ~..0.?. ................... Depth ............. ~..0.~. ........... 10. Date of Purchase ......... *j~...~..~..e. ......... ,/..~..(¢....~. ............ Name of Former Owner .d~..: ....... !.,.~<~(~.~..¢..~.. ................. t 1. Zone oL use district in which premises are situated ~Au 12.. Does pr?osed' construction violate any zoning law, ordinance or regulation? ........ ~ ................................................ 13. Name cjf Owner of premises ........ ..l~...~...n~.....~.~..-...Address ~'.Ch'~B.J4~f, Ja..S+-.,g["~Sehone No ..................... Nametf Architect ...................................................... Address ............................................ Phone No ..................... Name c~f Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from' property linesJ Give street and block number or description according to deed, and shaw street names and indicate whether " mtertc~r or corner lot. STATE OF NEWe,YORI~,~ /~/ } ¢ S COUNW ' ............. : ........ ,....~.~.~.~,~ .......................................... be.rig duly sworn, depbses and says that he is the applicant (N.~'me of individual signing application) above named! He is the ~ (Contractor, agent, corporate officer, etc.) of said awner or o~vners~ and is duly authorized to perform or hove performed the said work and to make and this applicati.on; that all statements contained in this application are true,to the Best of his knowledge and belief; that the workiwill be performed in the manner set forth in the application filed therewith. Sworn to befdre me this ~ i day of ....~~ 19..~-,-~. ....... ............ " ' .... Notary Publi~, ... County (Signature :~ Ierrn xp~res March 30, D U P P'E'E "