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Home My WebLink About2901-zTOWN OF SOUTHOLD BUILDING DEPAi~TMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, C~ERTIF~I~ATE Elf O[:OUPAN~Y THIS CERTIFIES that the building located at . ,~, ,~.~,..~.. ,~..~,~,~.~.. ,~,~. ......... Street Map No..~ ........ Block No. ~,~ ......... Lot No..~ ...... ~.O.~..~.~.~. J..~. ............ conforms substantially Go the Applicati,on for Building Permit heretof, qre file.d in this office dated ............. 0.~.~ .... 1,.~.., 196~. pursuant to which Building Permit No. ~.9.0~..~.. dated ................ .0¢.~.. ,I[5 19.65., was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The o.eeupaney for which this certificate is issued is .... I~V. ~.~. 0~1~. £alaJ, lF..~1~t~, l:l,t~g ........................................ The certificate is issued t,o . .~'Ol'aa. ,P.e~4~.~da]ag~lo..&. l~IJ.f~ ................ ~1~... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval ..... ~e~.~.1~I~.~.R.. ~.~..1~}.~5 ............ FOI{DI NO. 2 TOWN OF $OUTHOLD 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? 901 z Date ........................... 0¢l.t,o.t~, lt..... ], ~'. ...... , 19.6~.. Permission is hereby granted to: ...3 2.9 .....~,phan~..l~ ......................................... ....... ~ .,....~ .t..c..b.C~. ~ ...~l~ .~ ............................. to ....... $.~1~1~1 .. ~le.~.. rune..., fa~.~l¥...(t~e3~ ~g ................................................................................ ct premises located at ....Jl~.ed..&..l~he~,...li~ad .............................................................................. ................................................ lt~w.. ~ ~tt?~e3~.r ....N,-1f., ....................................................................... pursuant to application dated ................................... ~¢~....~1~ ...... l(J~,.~..., and approved by the Building Inspector Fee $~.~ ~,~) ............ SUFFOLK COUNTY DER~RT}Mi~T OF HEALTH Date. ~ ~h/~ / .... Building Permit NO.__~_~9 / ~ TO ~,~IG.~ IT M~Y CONCERN: The sewage disposal facilities for a structure located ag ...... deed lo.cati%n) ' ~ - M~_~_ ~.~..~:Fo L lc' ,,/ , ~o~ ~' ~o[,[ have been ~nspec%ed b~ %~s ~epa~tc~en~ aha $o~ ~o ~e sa~sCao~o~. RECEIVED 1~;5 DEC 21 P~ 2:~0 DEPARTMENT OF HEALTH RI~/ERHEAD , N'. 8? 2~'2CY'W. ~ 145.0 50' P~OPOS~D JOHN ~o. F ~it,~l'hwohl N, 8:' 2l'30'~. !4-5.0 FORM ~qO. I I~)WN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ~ /3- Examined ........................................ , 19........ ~-~ Approved ..................... '..~ ................. , 19..:.'.... Permit No. c~ .......... ~O...... ....... / ~..... ........................ ................................ (Building Inspectop Application No. ,. ~c~...~'..~./. .......... APPLICATION FOR BUILDING PERMIT Date ..~ ........... ../.....~... ...................... , 19.~..Z 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 port 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 o 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 apply'ant) /x~'~,,~, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... ~z~...~..~..,~..~.......4...~..~.....~..~..~.~& .......................................................................................... Nome of owner of premises .......~..~...~,.....~.......~.... ,.~...../-.~-..~..~...~..-- ./~..~.. ......... ..~..~...~...-"..,~'.~..~.~'~.~'.~-.~/~7 ............... If opplical3t, is a co~orate,~ s~gnature of dully ~orized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. rMap No.: ........................................Lot No.: ........................ Street and Number ... ,~.,,/...~... ...... .~..~4~...~.'~..'......~...,~........~..~...~,~...~./~.../~....~......Z~..~..~.~......~..,.. .... /~,-~/ ~ ~~ Munici~li~ 2. State existing use and ~cuppncy of premises and intended use and occupancy of propos~ construction: a, Existing use and ~cupancy .~.~~ ......................................................................................................... b. Intended use and occupancy ....~.Z~....~T~/~ ...................................................... 3. Nature of work (check which applicable): New Building ....... Addition .................. Alteration .................. ~ . ~ ~ Repair .................. "~,,e ~,,Rem°val .................. Demohhon .................. "~-"~' ~/Other V~ork (Describe) ........................................ ':4~, Estimated Cost .... ,,~d...~.~...f. cf~..~.. ................................... Fee ....... ~.,...,.~..,.¢-%.. ....... ........................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .(~c/... ............ Number of dwelling units on each floor ............................ If garage, number of cars ......~,~.. .............................................................................................................................. 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 ...~.1~...~. .................. Rear ..... ~...~.. ............... Depth ..~.....~... iiiii Height ....~.~. .......... Number of Stories ........ ~ ............................................................................ i'..iiiiiiiiiiiiiii'. 9. Size of lot: Front .~.J,.~..~.....~,.... Rear ............... Depth ...~'..~..~.....:. ............ 10. Date of Purchase-....¢~.~.~.~.~...~..~.~x~....- '~'~ ~ .................. Nome of Former Owner'~ --~'~--~'-- ,~-Z~...~T......(~f~'.~..~.X~.~,~,~ ...... 11. Zone or use district in whic~'premises are situated ...~'.'-'~''''~''~'.'~'.~'~'~''~''''~''~' / ................................................... 12~ Does proposed construgtion violat,e~a~v zoning law, ordinance or regutation~ ' ':;'?;:; .................. 13. Name of Owner of premises .......~..~'.~'~.~?~.. .......... ~Address ~.~....~...~.~..(..~.~. ............ Phon~ No ............ .'...~.f.f. Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~..~...Z:.~....~......~...~....~....~..~-.~.c.--~-~....~-.....-6~ress ,~e~-~,~,~'~' ...~. Phone N,~.~. .......... PLOT DIAGRAM = ~ Locate clearly and distinctly oil buildings, whether e~xisting or proposed, and indicate all set-back dimensions f~b~ property lines. Give street and block number or des~cr,/ption according to deed, and show street names and indic0te whether interior or corner lot. ~ _ STATE OF NEW'~R~,/~ . /~ te~ ~z ~ ~/~ COUNTY r ..... ~....~.~ ................................. being duly sworn, deposes and says that he is the applicant (Name of indi*idual s~g ~~_ ' above named. He is the ...~ ................................................................................................ : ......... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hav~ performed the said work and to make and file this application; that all 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 b~o~ me this ~ ~ /~ ......... ....... ....... ...... ............................................... Nota~ Publi~.~~~:,*u .~t~ ~ ~ v0(r~ignature o~nt)