The URL can be used to link to this page

Home My WebLink About3212-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E~EI~TIFII~ATE I-IF []OOUPANI~Y No. ~; 2~1~3 Date .... ~'t~.. THIS CERTIFIES that the building located at Map No. ~ Block No. ~ .Lo~ No.~. ~Ut~t. ~,y, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated -- ~S~ · ~ 19 ~ 0ursuant to which Building Permit No. dated ~ep~ ~ ~ 19 ~ , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~i~&~ O~. ~mi~ .d~l~ ................................. The certificate is issued to ~O~ ~l~ ...... ~ ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .......... Building Inspector FOI~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N? (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ~ Z Date ............................. ~l~ljl~.e.~.~....~......, 1 ~.... Permission is hereby granted to: g~o~'~e.. J~lzl,ez,~..A/C..Jatm...A~l,e~ ................. to ~t.t~..zm~...l~e.. ~.. Z:~a~t~ ................................................................................... at premises located ct .~.j~....a~O~t.w..~..]J./jj..~el~l~..~d~.~l,j:~O~..~__ .......................................... .................................... ~m~!~.....tt~, .................................................................................... pursuant to apphcation dated .............................. ~I~[i~t~....~I~ ...... ~9~...., and approved by the Budding Inspector Fee $~1~.~.t~1. ............ Building Inspectorf S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The ,sewage disposal facilities for a structure located (Give deed lof~ion) have been inspected by this department and found to he satisfactory. ~i_~+.v~ Q~ ~nee~ ,~, ~.,, District~ Engineer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~....Z ....... ,19....~...~ Approved ........................................ , 19...~.i.. Permit No. ......... ~..../~ ............. ~.. Disapproved a/c .............................................. ...................... ................................ APPLICATION FOR BUILDING PERMIT Date ............ ~,.~...~..~ '~ .... 19 .... INSTRUCTIONS a This apphcation must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin Inspector. b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets · areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio, c. The work covered by th~s application may not be commenced before issuance of Budding Permit. d Upon approval of this apphcat~on, the Building Inspector will ~ssue a Building Permit to the applicant. Such perm shall be kept on the premises available for ~nspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever untd a Certificate of Occupant shall have been granted by the Buildmg Inspector APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ The apphcant agrees to comply with all apphcable laws, ordinances, build,ng code and regulations~ ( 'g '"o- ¢~Wp,,,cum, or name, if a corporation) State whether applicant is owner, lessee, agent, arch~te, c,t, engineer, general contractor, electrician, plumber or budde ................................. ....... ............................................................ Name of owner of premises ~ ........ ](~..~..~./.!3 ............ C .~...~[ ............................................. If apphcant is a corporate, signature~f duly authorized officer. (Name and title of corporate officer) 1 Location of land on which proposed work will be done Map No .......... , ......... Lot No .............. Street and Number ..... .~...~ ...... ~.:~ ...... ...~...C..'~....~..c.'.Z ..................................... Municipahty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction Existing use and occupancy ............................................................................. - ........ Intended use and occupancy ........................ ~r~..~. .~..%t. ..................................................................... 3 Nature of work (check which applicable). New Building ..... ~ ...... Addition .................. Alteration ................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ....................................... 4. Estimated Cost ..........~../....C.~.~..O. .................................. Fee ......................................................................................... (to be paid on filing this application) 5 If dwell,nc, number of dwelling units ........... ~.. .............. Number of dwelling un,ts 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 Stones .............................. 8. Dimensions of ant,re new construction' Front ........... .~...?]....~ .......... Rear ........ ..~..?...~.~.~. ...... Depth .....~..~·..~..~...~./.... Height ........ .~...~. ..... Number of Stories ................. ~ .......................................................................................... 9. Size of lot: Front ........ ./.~..S..~.....~ .... Rear ........... /.I. ~ ............. Depth ......./.~..~ ............... 10. Date of Purchase ...... ~'.-....~..'~ ............. ./.~.~..~.. ..... Name of Former Owner ..................................................... 11. Zone or use d~strict in which premises are situated ........................................ /~. ...................................................... 12 Does proposed construcbon violate any zoning law, ordinance or regulation:) ...... 4~..~". ................... .,..~ ............... 13. Name of Owner of premises ..~..~..~......~.~...~..~., ......Address .~'..~. ~ ~---.¥. phOne N,/~ :.. Name of Architect ..................... ~.~.~.~.~ ................... Address · ...................... ..., ............. Phone No ................ Name of Contractor ~..'.¢..: .... ............................... ~-c~'~ .Address ....~.....~..:..'.~..~ Phone No PLOT DIAGRAM Locate clearly and d~st~nctly oil buddings, whether ex~sting or proposed, and indicate all set-back dimensions fron property lines. Gwe street and block number or description according to deed, and show street names and indicot, whether interior or corner lot /....,., !1 ~' / STATE OF NEW YORK, ~' S S COUNTY OF~.~, ......................../"-m~)~,~"'}l ' ' ....................... ~%.~.~ ..... .'m......~-'fLX~..'.¥ff.. ....................... be,rig duly sworn, deposes and says that he ,s the apphcan (Name of i~chv~dual signing apphcat~o_n) above named He Is th- e (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and this apphcat~on, that all statements contained ~n this apphcahon are true to the best of h~s knowledge and behef; an, that the work wdl be performed in the manner set forth m the application filed therewith. Sworn to before me this ....... ....... do, of ..... ...... , i. . ...... ...... ....... ....................... Notary Pubhc,/.~..~~./~Z .............. A~mmty ,~u_~ (Sig(~ature of applicant) ^ uomm'Jsslon £xpzres