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Home My WebLink About3225-zFORM 1~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT ·'OWN CLERK'S OFFICE SOUTHOLD, N. Y, OEI~TIFIOATE OF or.r.I]PANr. Y No. Z. 266:1, · .. Date .......... Feb,a~a~, · · · ':13 ..... lo.6?. THIS CERTIFIES that the building located at EY'S' "P~d~1'~e' P01rit' 'l*(S&klStreet Map No. ~ ........ Block No... ~ ....... Lot No. ~¢~ ..... Southol~-N~Y... ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ep'~ .... l~'" ', 19.(:~. pursuant to which Building Permit No. dated .......... SOp'~ .... ~.~ .... 1966., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The occupancy 5or which this certificate is issued is R~l~at~ .one-f~i~y. c~we'~t~t~g ......................................... The certificate is issued to Dry,..je~,~¢~, .O~l~s ...... (owner, I~essee~r~rl~e .......................... or tenant) of the afore, said building. Suffolk County Department of Health App~oval .... '~a~ ' ' 26{' ~67" Sy 1~;' ~tll'& ' ..... Building Inspector\ ~01~ ~0, ~ 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) N9 3225 Z Date ....................... ~tlep~ll]~e~-...~9 ..... , 19~. Permission is hereby granted to: ct premises located ot .~.~....]~(]~ .]11~1~..]~)1~ ............................................................... .................................... ~~....~.~. .................................................................................. pursuant to applicatiSn dated ......................... .~it~.~llt'bel~.....~ .... 19(~ ..... ond approved by the Building Inspector Fee $..]~1. ~0~) .......... Building Inspector / S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH ~AN 2 6 1967 Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. District E~ineer District EngiR~'~} FO]~M NO. 1 TO~ OF $O~THOLD BUILDIHG DEP~RT~EHT Tach CLERK'S OFFICE SOUTHOLD, H. Y. .... ...... Approved ........................... : ............ , 19[: ..... Permit No. ~ ............ 2 ~. .............. 7 ~. ................................ ........................... APPLICATION FOR BUILDING PERMIT Date ....... ~...../. ~.~.. ........... INSTRUCTIONS a. This apphcotion 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 buildings on premises, relationship to adjoining premises or pubhc streets c areas, and giving o detailed description of layout of property must be drown on the diagram which is part of this applicatior c The work covered by th~s apphcabon may not be commenced before ~ssuonce of Budding Permit. d. Upon approval of this application, the Building Inspector wdl issue a Budding Permit to the opphcant. Such perm~ shall be kept on the premises available for inspection throughout the progress of the work. e. No building sh~ll be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupanc shall hove been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of o Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply with all applicable laws, ordinances, building code and regul.atiops (S gnoture of 'OJppJicont, or name, If o corporation) f? ..-,_p 1/'7 ................. ..... ...... ........... ~j (Address of applicant) ~J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildm ................................................... ........ Name of owner of premmes .................................... ~ .................... If apphcont is a corporate, signoture of duly authorized (Nome and title of corporate officer) 1 Location of land on which pr. fkoosed.work will .b~ d/gne ~g~ No ...... _ · . .~ .../, Lot No ...................... Street and Number' .... ~..~~ ......... ~. ~ ................. ~~~ ............................... Munic~lity 2 State existing use and occupancy of premises and intended use and ~cupancy of proposed construction a Ex~stmg use and ~cupancy ............................................................................................................. b Intended use and occupancy .................................. ~& ~Y~ .............................................................. 3. Nature of work (check which applicable): New Buffdmg ........ ~ .... Addition .................. Alteration ................. Repair .................. Removal .................. Demohtion .................. Other Work (Describe) ....................................... 4 Estimated Cost .......................... ~.).~ .C). ~.{.~. ............... Fee ........................................................................................ (to be pa~d on fihng th~s application) 5. If dwelling, number of dwelhng un~ts ............. ~.. ........... Number of dwelhng umts on each floor ........................... If garage, number of cars ........................... ..~ ........................................................................................................... 6. If business, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7 Dimensions of existing structures, if any. Front ........................... Rear ................................ Depth .................... Height ........................ Number of Stones ............................................................................................................ Dimensions of same structure with alterations or additions Front .................................... Rear ........................... Depth .............. ~.z ............. Height .......... ~ ....... Number of Stories .............................. 8. Dimensions of entire new construct,on' Front .......... ~.~. ................. Rear .......... ..~....'?. ........... Depth ....... .~...~...~.? ..... Height ......... .J..~. ....... Number of Stories ........... ./. ............................................................................................... 10 Date of Purchase .................................................... Name of Former Owner ...................................................... 11. Zone or use d~strict in which premises are s~tuated ...................................... ~. ....................................................... 12 Does proposed construction violate any zoning law, ordinance or regulationP ...... ~ .................................... Name of Architect ................................................ Address ........................................... Phone No .................... PLOT DIAGRAM Locate clearly and d~st~nctly all buddings, whether ex~sting or proposed, and indicate all set-back d~mens,ons fron property hnes. G~ve street and block number or descnption according to deed, and show street names and indicat, whether interior or corner lot. STATE OF NEW YORK, ............... ..,~.~....~.. ......... .L...~.~ ..................... being duly sworn, deposes and says that he ~s the apphcan (Name ofJind~vidua~ s~gmng apphcot~on) above named 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 ill, th~s opphcat~on; that all statements contained m th~s apphcat~on are true to the best of his knowledge and belief; an, that the work will be performed m the manner set forth m the application filed therewith. Sworn to before me this ,~ Notary Public,.~/~~u~ y ~-'~. (Stg~ e at app,icanr)