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Home My WebLink About3240-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. [3ERTIFIE~ATE OF E]P.E:UPANP. Y No. ~. 28~. Date .... TI-IIS CERTIFIES that the buildinR located at ~'~ D~e:~ D.~1¥O .... Street Map No.Dee2' P&~k Block No .... Lot No. ~16t . ~l~tl;;l~tCkt~ .[~,w~, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated .~e~: ~.~ , 19 ~ pursuant to which Building Permit dated 8e]~; 28 , 19 66 , %vas issued, and conforms %o all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ~'~[~at;s. ~me. £amflF .dwe/3&t~g ................................. The certifmate is issued to ~e~l..)~10,~ ...... (~F~%' ............................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ·'/~~ding Inspeeto"r~ ........ FORM TOWN (~F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT CI'HI~ PERMIT MusT BE KEPT pN THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) / 3240 Z Permission is hereby granted to: Build. ing Inspe?t~r. , \ ~ Building Inspector pursucmrc to apl~lication dc~d ................. ..,.!.~.t,e~[~tj~ ....... a8 ..... , 19..~., and app;oved by the S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date JUL ~ ~' 1967 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at Deer Drive 4~l/w/o Westholid Road~ Mattituck (Give deed location) have been inspected by this department and found to be satisfactory. District Engineer~ District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq, Y, Disapproved a/c ............................................................................................. ...................... ................ .............. (Buildm?nspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Thcs application must be completely filled in by typewriter or in mk and submitted in duplicate to the Buildi~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and gwing a detailed descnption 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 Building Pertain d Upon approval of this application, the Building Inspector wdl issue a Building Permit to the applicant. Such peru shall be kept on the premises available for inspection throughout the progress of the work. e No building shall be occupmd or used in whole or in part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ,ssuonce of a Building Permit pursuant to t} Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances , Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as here~n describe. The applicant agrees to comply with all apphcable laws, ordinances, building code and regulations. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildc Name of owner of premises ..~....~.....~....~.~....~...°.....~'-...~.~..~ ~. ............................................................ If apphcant ~s a corporate, signature of duly authonzed officer. (Name and t~tle of corporate officer) 1 Locat,on of land on which proposed work will be done Map No ...~...~..O.......~. ........... Lot No ..... !..~. ......... I Street and Number ,~...~...~....~..~...~..\ ~...¢~,) ...................... . ............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction a. Existing use and occupancy ............................................................................................... 3. Nature of work (check which applicable)' New Budding ;~ Addition - ~ Alteration Repair .................. Removal -- Demoht~on ...... =..:.; ..... Other Work (Describe) 4. Estimated Cost ..... ..~.....~...?~...O....O.. .............................. Fee ...................................................................................... (to be pa~d on filing th~s apphcahon) 5. If dwelling, number of dwelhng units ................ .~.. ........ Number of dwelhng umts on each floor If garage, number of cars 6. if business, commerctal or m~xed occupancy, specify nature and extent of each type of use ....... ~ ...... :..: ........ existing structures, if any. Front ..... ~ ............ Rear ....~ ................ Depth ....~ ...... 7 D~mensions of Height .... ~ ..... Number of Stories ....... ;.:.~hZ?. ...................................................................................... D~mens~ons of same structure with alterations or additions. Front ....................................Rear Depth ................................ Height ........... - Number of Stones ...... :.. ......... ~ ........... 8 Dimensions of entire new construction' Front .......... .~.....~....~ ............... Rear ..... ~...~....~ ............ Depth ..... ..~....~.. ....... He,ght ....~-...~.~....~.~... Number of Stor,es ............................ .. ~ .......... ~......; ........ i.~.l~....~..~_~.~, ............................. 9. S~ze of lot: Front ...!....'~....?. ............. Rear .......................... uep~n ............. .Z.! .............. 10. Date of Purchase ....~....-T..~...~.....'Z.~...L:'.. ................... Name of Forme~ Owner S ~s* ~ 1 1 Zone or use district in which premises are situated ..... 12 Does proposed construction violate any zoning law, ' ...................................../"\ "" ordinance or regulat~on~ ............................................... 13 Name of Owner of premises ~%..~...~.....~9...~.~...~.~. Address .-~....~....~..Z.~........I~...9.~.'~..~ Phone No ~..~..OI..Z..~...~. Name of Architect ........................................... Address ....................................... Phone No ................. Name of Contracto~.~,..~...~....~....~....~. ~...~. .......... Address .~.......'~...~...?.~... ~..~...~.......~. hone No ..~.).D.~Z ~.~ PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~sting or proposed, and red,cate all set-back dimensions fror property lines. G~ve street and block number or description according to deed, and show street names and red,cat whether interior or corner lot STATE OF NEW YORK, COUNTY OF ................................ ~ .... ......... ~..~....~r ..... .~..........~....~.'..~,~.O...~....~.~....~ ........ .... being duly sworn, deposes and says that he ,s the applicc (Name of individual szgnmg apphcat~on) above named He ,s the ......... ~.~.~.~ ............................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authonzed to perform or have performed the sa~d work and to make and fil this application; that all statements contained m th~s apphcat~on are true to the best of his knowledge and behef, an that the work wdl be performed m the manner set forth m the application filed therewith Sworn to before me this ........ ....... . ' ..... .............................................. Nota~ Public, ~~Count~~~t)