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Home My WebLink About2894-zFOI~M 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. I~EETIFIOATE OF O00LIPANOY THIS CERTIFIES that the building located at .]~/~1...~[~.~.]t~V~ ......... Street ~a$~.~?..?.~L .~.~..~& ~. ~..~.a?..~ ...... *.ot ~o. 1-~..-.-~...~reenror.%. ~.~... conforms substantially to the Applicati.on for Building Permit heretof~ore filed in this office dated ............. ~l{IJO'~. · 8.., 19.~. pursu'ant to which Building Permit No..~8~t1.-2[. dated ............. 0~...~ ..... 19(>~., was issued, and conforms to all of the require- me.nts .of the applicable provisions of the law. The .occupancy 2or which this certificate is issued is ... ~.lrR~tg' one' .£a~ily- ~lwe~['~L,a'g ' ....................................... The certificate is issued to . [owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ..... ~Ug. ~.,. '~966' "by' '1t~' 'V~'~lt~ ..... FO~M NO. ~ 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? 2894 z Date ........................ Permission is hereby granted to: ..... C,~eet.. ~i~ er · C~boad .................................... ............ Oe'e~t--'Rive~r ~'""N;.y;. ........................ to ..Cenve~.t.. e~.s $,in~.. ~arm..~u~L.~d~ng..t~.. re,dense ................................................... ~t premises located at ....g/~.....{~l'm,'in"])]:¥~ ......... .............. ].at s...1.$~..2 ......... ~trae~per. t r.8,.Z., .............................................................................. pursuant to oppl{cot{on dated ................................ 8e.])t .......... ~ ...... ]9.~., and approved by the Bui{ding {nspector Fee $'"~0~00 .......... S-9 SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~. ~er~t ~o. ~. ~' ,,~ ~ 2_ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at (Give deed location) have been inspected by this Department and found to be satisfactory. FOI~M NO. 1 ~' 'TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....~ ..................... , 19.~.~. APPLICATION FOR BUILDING PERMIT Date ........................... ~,~e.p,t;~he;~.....8..., 19..6.~i' ..... 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 o detailed description of layout of property must be drown on the diagram which is part of thi.s 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, ohd 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 nome, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder. .ud.ol Kolll~k ~C ~ka~s Xne 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. ,Mop No.: .~O~..~..~~~,.~ Street and Number ~/~ ~.~'~,.~'~ ............ .~.~P~ ............. ~ .... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~..~ ............................................................................................... b. Intended use and occupancy .~.~.~.~...~...~.~.~. .............................................................. 3. Nat~re of work (check which New Buildih'g" ~..' ................ Addit ................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ...... ~l~.~y~I.O~l ....... 4. Estimated Cost .......................................................... :.Fee ..... 'lO~0~e paid on filing this application) 5. If d~velling, number of dwelling units ......... ~ ............ Number of dwelling units on each floor If g~rage, number of cars 6. If lusiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front ...... I~J,~,-I~ ......... Rear .......... ll,[.i~ ............ 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 Hei~lht ........... : ........ Number of Stories ........................................................................................ 9. Sizelofj lot: Front .~9,1,14-~..~.l~ ....... Rear .................................... Depth "JI'/~8~"&"W/"~JJ P/~[ 10. Dat~ of Purchase ............. ~.~.~. ................................ Name of Former Owner ......... J~"l'ecT,~J~,'"~'~t,' .......... 1 1. Zonb or use district in which premises are situated ...... #~#..~.~. 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... 13. Nar~e of Owner of premises RI~lo'I.~..~I~I]~. ...... Address '*"(J~'el~,~S."~t'~.'~¥'~. Phone No. Nar~e of Architect ...................................................... Address ............................................ Phone No. Name of Contractor ..... ~t11~ ...................................... Address ............................................ Phone No. PLOT DIAGRAM L.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property li'nes. Give street and block number or description according to deed, and show street names and indic whether inerior or corner lot. , j ~,.,~ ~, ~,~ t~ _.__~--~'~-~ ...... "STATE OF. NEW YORK t ¢ e · COUNTY OF ..... ~1~.£~ .]~ .......... ~ .... ....................... ~l~dolj~h..~....Jr,~lJl~J[ ................ being duly sworn, deposes and says that he is the (Name of inaividua sign ng appl cat on) above na~ed. He is the .............. 0~J~.. ~ I (Contractor, agent, corporate officer, etc.) of said o~Jner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this applicatk~n are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. Sworn to b~efore me this gnature of applicant)