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Home My WebLink About2919-zFORM ~0. 4 TOV~rN OF SOTJ?I-IOLD BLTILDXNG DEPARTMENT TOW'N CLERK'S OFFICE SOUT'rlOLD, N. ¥. OEI~TIFIOATI~ OP O00UPANO¥ No. Z' '2~r%6 .... Date ................. Jtme.. THIS CERTIFIES that the building located at .Meadow..Lane ................ Street ~la~iXtd;UCk..Es.t;at~Slock No ....... XX .... Lo~ No. ~3~" 'Ma~ci;i'l~uek~· };~Y', .......... conforms substantially to the Applicati,on for Building Permit heretof,ore filed in this office dated ........... ~OV.~ ..3 .......196.~. pursuant to which Building Permit ~Wo..2.9.19. dated .............. NO.V.,...3.., 19.6.~., was issued, and conforms to all of the require- merits rOf the applicable provisions of the law. The .occupancy for which this certificate is issued is PriVa.~e · o,tqe..fan~.ily..dwoll:i,ng ............................................ The certificate is issued ~o Edwa~¢/~ .AD'its .Colzt-I, ae.l~or..I~te .... ,Qw~er ........... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval . J. ztlrte.. ~.~.-1.966--.by. R,..V. il.l.a .... Building Inspector 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? 2919 Z Date ........................... ll~emb~.....3 ......., 19.6.~.. Permission is hereby granted to: Ed~..Ab;Lt~,..Cor~t~.actor....Zrm ................... .................... I~t t.i.t~lek. ...................................... to.... J)u:l~ d..ne~...one .. Sams ~.~.. 4~:~.1 .i.n~ ................................................................................... at premises located at ...... ~(~t...~:~ .......... l tt t mk...] eta, tee ...................................................... ................................................. Mea~o~..Lane ............ Matt~t~ic ..................................................... pursuant to opplication dated ........................ ]J(~t ......... 3 ................... 196~..., and approved by the Building Inspector Fee $.~ f'l., 0~0 ............ Building r~spector s-? SUFFOLK COUNTY DEPA~dI~ENT OF HEALTH Date Bldg. Permit No, ... TO WHOM IT MAY CONCERN: The sewage disoosal facilities for a structure located at have been inspected by this Department and found to be satisfactory. District Engineer District Engineer NO. I 'IK)WN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~?.?.' ~ / / APPLICATION FOR BUILDING PERMIT 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 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 this application, the Building Inspector wilt 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 Deportment 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, os 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~...~t~l~.e~. .................................................................................................. Name of owner of premises ...... ~/.,...~.J).~.t~...]~:t ............................................................................................................ 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.: ....... }~L~,t~.~(~J~,..~.8..~.l~tt~No.: ..... ~'.,~. .............. Street and Number ..J~.~f]~/..~e ............ ]/~.~.~t~."~.~ ................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~k~...~t~.~ ............................................................................ ....................... b. Intended use and occupancy ........ .~.~.~....~.~l,~,~k~....d...~'.~...1,.]:..~...~.J~ ........................................................................... 3. Nature ~>f .work (check which applicable): New Building .,~¢~,Z~ ...... Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost .... '!~,~.000 ......................................... Fee ..... '~(~(to be paid filing this application) 5. If c~welling, number of dwelling units ....... ~).O .............. Number of dwelling units on each floor If g?rage, number of cars ..... ~)...Ol)~ ...................... 6. If 6usiness, 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 Dep.;th ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... 66 ........................ Rear ....... (~ ................ Depth ......... ,.~2 ...... Hei~lht .................... Number of Stories 9. Siz~ of lot: Front ..~1~1, ................... Rear .......... ]tO~. ................... Depth .~/..,~ ............ 10. Date of Purchase ......... ~.~ ..................................... Name of Former Owner ....... 1 I. Zone or use district in which premises are situated 12. Does proposed constraction violate any zoning [aw, ordinance or regulation? ......... 13. Nar~e of Owner of premises ...~.~,~[.t,~i.~.~....~l~.~t.t,~ldress ................. ~l),.t,~;~,~ ..... Phone No. Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor ..l~,(]~..~,~..t~ ........................... Address .......... ~),~;t.t~; ............ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block number or description according to deed, and show street names and whether interior or corner lot. STATE OF COUNTY ................. i ....... l~(~o..J~;~:~.t~ ................................................ being duly sworn, deposes and says that he is the applic ~(Name of individual signing application) abow~ named. He is the ........ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed t~e said work and to make and this application; that oil statements contained in this application are true to the best of his knowledge and belief; that the ~ork will be performed in the manner set forth in the application ~l~herewith. Sworn to ~efore me this ~ / ............... ~. day of ......................... ~, 19...~ Notary Public · Co~, ~. (Signature of applicant)