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Home My WebLink About2910-zFOR~ ~0. 4 TOWN OF gOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. OERTIFIP. ATE 13F 13~P. UPANP. Y No.. g.. 2}%92' ' · Date ................. AUgRS.t · 8 ..... , 19.66 THIS CERTIFIES that the building located at ...]~1./.$...~lr~y..Lar~e ........ Street Map No .... XX ...... Block No ..... ;gX .....Lot No...X~ .... Ne~r. S~/ffolk ........... conforms substantially to the Application for Building Permit heretof, oTe filed in this office dated ............. 0e.~ .. 2~ .... 19.6~ pursuant to which Building Permit No..2-~10. dated ................ I~IC~..2~., 19..6.~ was issued, and conforms to ali of the require- ments ,of the .applicable provisions of the law. The .o.ccupancy f. or which this certificate is issued is .... Pr~.va%e · (>ne..f. am. ily..dwelling ........................................ The certificate is issued %0 ...V.~.~eel%~6. <}loasoa ............ (~wi%e~ .................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval .. { ~"~Building Inspect~ "~ ..... ~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CI~ERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ONTHE PREM SES UNT L FULL COMPL£TION OF THE WORK AUTHORIZ£D) N? 2910 z Date ..... 19... Permission' is hereby c[ranted to: ..~ f~, . .~ of premises located at .......................... ; ................... ( ..................... , ........................................................ pursuant to application dated ............................. ;.,...,..., ..................... ' 19~.J...., and' opproved by the Building Inspector SUFFOLK COUNT~ DEPAFCMENT OF HEALTH Date have been inspected by this Department and found to be satisfactory. TO WHOM IT MAY CONCERN.. The sewage disposal facilities for a structure located at Distriot Engineer DistriCt Engineer FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ c:~' 19 App roved ~ t " ~- 7 / Z ....... ........................................ , 19 ........ Permit No ............................. Disapproved a/c .............................. :.~.~.~..~.....-~ ........................................ ' /~~, specter) .............................. Application No ............................. APPLICATION FOR BUILDING PERMIT Date (~ ~/ ( c~ ~' 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 premi,ses or punic streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is pa.rt 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, building code and regulations. (Signature of applicant, or name, if a corporation) .............. ................................... (Address of opplicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................... ................................................................................................ 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.: ....... ~., ........................ Lot No.: ..ii~: .......... Street and Number .................................................................... Munici~lity 2.State existing use ond occupancy of premises and intended use ond occupancy of proposed construction: a, Existing use and occupancy ........... ~.~..~:,~.,..~.~. .................................................................................. b. Intended use ond occupancy 3. NatUre of work (check which applicable): New Building ..... ~ ........Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ..... (....~...t...J)~ ................................. Fee .../. (to be paid on filing this application) 5. If dlwelling, number of dwelling units ....... ~.~Number of dwelling units on each floor ........ If g~rage, number of cars ................. .~...~k/ 6. If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Din!ensions of existing structures, ~f any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Dimensions of same structure with alterations or additions: Front ....................................Rear Depth ................................ Height ............................ Number of Stories ................................ 8. DimJensions of entire new construction: Front .......... .~...~ ................. Rear · ........................... ~'~' Depth Height .................... Number of Stories 9. Siz~of~ lot: Front ..... .~.....~... ............ Rear ......... ~....,~.. ................. Depth ....~..f-J ~- 10. Date of Purchase ....................................................... ~Name of Former Owner 1 1. Zone or use district in which premises are situated .....~ .............................................. 12. Doe~ proposed construction violate a~y zeal, nc law, ordinance or regulation? ........ ~ Na~e of Owner of premises ..J~...~.....(~.... 13. __ ...~.../~..~. ~.~.......Add ress ............................................ Phone No. Nar~e of Architect ...................................................... Address ............................................ Phone No. i ......~....~...~'~.....~.~...~..~..!.~....~..'~. .......... Address ........ .~.....'.~....'~.~.C"...~... (~u,~ Phone No. Narhe of Contractor ....................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines. Give street and block number or description according to deed, and show street names and indic whether interior or corner lot. STATE OF' NEW ~¢ORJ~/~ ,,~,~ } c c COUNTY jOF~//~_,,,~ ~' .4~/~~''''1' °'°' ................. ~.~--~..~ ....... , ........................... bein~ duly swom~ doposos ~nd ~:(Name of individual signing application) ' obove no~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 this applic?tion; that all statements contained in this application are true to the best of his knowledge and belief; that the wgrk will be'performed in the manner set forth in the application filed therewith. Sworn to b~for~ me this /~ I ~ , ~ ............. of ............... ........ / Z : ~-'~, ,. ~t~t~ T. ~OK~ ~'~ says that he is the applic~