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Home My WebLink About3242-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFICATE DF BI~P, UPANDY No.2; 28t~ . . Date ....... ~ept' 2't.. , 1969 THIS CERTIFIES that the building located at .W/S l~ort-h West Loo~ Street conforms substantially to the Application for Building Permit heretofore filed in this office dated 8ep~'"2~ ' , 19 66 pursuant to which Building Permit No. ~2~2 ~ dated ~ep~ 29 ,19 66 ' was issued, and conforms to all of the require- ments of the applicable prowsions of the law. The occupancy for which this certificate is issued is P~iva~e .~e ~ami-~;y. ~,~3.t[f~g- ................................. The certificate is issued to . . A.~ti~um S%a~ey ..... 0~er. ................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .~,t ~ ]96~. .~. R, .~t. lla Building Inspector ~ TOWN OF SOUTHOLD BUILDING DEI'~ARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING ~PERMIT ~. (THIS PERMIT MUST BE KEPT ON TH[ PREMISES UNTIL FULL COMPLETION` OF THE WORK AUTHORIZED) Permission is hereby granted to: ..... ~...~~..~.f....~.,.~..~ ......... ......... : ....... ~.t..,.~.~r.~,.....~.,.~ ................... to ~.~..~....0.~..~.~..~...~.*.~ ................................................................................... at premises located at ...~../.~......~r.~.ll~-~....~.~.~...~e~.~ ....... i...~i.~i..~.~Lt...;~.......~...~.~...~.~. ............. ........................ ~.e..~ ..~. ~.....~.e..~.~....o.~.~k.~., ....... ~.h...o..~... ,,.~..,.~.,. .................................... pursuar~' to c~oplication dated ............................ .~.~ .......... ~. ....... , 19~.:., ond approved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH $£p 81967 Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ' ~ (Give dee~ ~ocation)~ have been inspected by this department and found to be satisfactory. District Engineer District Engineer FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ~.....~.....~......., 1 9.~..~. Approved .......~.......~.....~.. ........ , 19.~..~...Perm,t No..~....'~......~....~......'~Z.... D,sapproved a/c ...,.~.~_~...~~ ........ APPLICATION FOR BUILDING PERMIT Date ........... ~ ............................... ~%.~ , ~, ,C 19 .......... INSTRUCTIONS o Thts application must be completely filled ~n by typewriter or in ink and submitted in duplicate to the Buddin Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adloming premises or public streets areas, and gwmg a detaJled descrJption of layout of propertymust be drawn on the diagram which is part of this applicatio~ c The work covered by this opphcotion may not be commenced before issuance of Budding Permit. d. Upon approval of this application, the Budding Inspector wdl issue a Building Permit to the applicant. Suc permit shall be kept on the premises ovadable for inspection throughout the progress of the work. e No budding shall be occupied or used ~n whole or in part i%r any purpose whatever untda Certificate of Occupan, shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Budding Permit pursuant to t} Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances , Regulations, for the censtruction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply with all applicable laws, ordinances, b. uild_mg code ar4d recju~t~onL - .~ . (S~gnature of applicont, or name, if o corporot~on) ....... (Address of app41cant) //' ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or buildc Name of owner of premises ..~ ...... .~....~..~~ If applicant is a corporate, signature of duly authorized officer ....... ............ ................ (Name and t~tle of corporate officer) 1 Locat,on of land on wh,ch proposed work will be done. Map No .~,~,;~:~.~..~.~.]. ...... Lot No' ,,~..~....~....~ Street and Numbe ..r~..~.......~....~,~..~...~..~.. ........ ..~..~1,~..._.~...~../../~.~....; ................................. Municipality ~/ ................. 2. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex~sting use and occupancy ............................................................................................................................... b. Intended use and occupancy .......... ./....~.~~. .................................................................................... 3 Nature of work (check which applicable). New Building ...... ~ .... Addition .................. Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4. Est,mated Cost ........~.....O..>..~..~ ............................ Fee ......................................................................................... (to be paid on filing th~s apphcation) 5 If dwelhng, number of dwelhng units .......... /.. ............... Number of dwelling units 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. D~rnens~ons of ex~shng structures, if any: Front .......................... Rear .......................... Depth ........................... Height ............................ Number of Stones .............................................................................................................. D~mens~ons of same structure wnh alterations or addmons: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8 D,mens,ons of ent,re new construction: Front ~' ~- ~' ~'~' ~ ~' h~....~..~...~.?. ............................ Rear ............................ Dept ...~. Height ....... ---- '~r/..~....'. ......... Number of Stories ........ ~ .................. / 9 Size of lot: Front ...~.~..~....~. ..... ~,.. Rear ...... ~...~..~. ......... Depth ...~...~..~ ................... 10 Date of Purchase ...........~...~..~.~....~... .......................... Name of Form~/;' Owner .J4:L:F,¢~ ....... ~..(,'~.~,~.... 11. Zone or use district m whic~h premises are situated ....... ...~. ....../4g..t...~......x .......................................................... 12 Does proposed construction wolate any zorur~a law, ordinance o_r regulation? .... .~.~..'~. ........................................ 13 Name of Owner of prem,ses ~r~...fcf~....~.~,dress ~..~'~.~...~....~... ........ Phone No .................... Name of Architect .... ..~ ............................................ .~ddress ............................................ Phone No .................... Name of Contractor ~.~...~.~~., ....... Address ~.. ~..,~/,~.....~.. .......... ~.. Phone No. ~....~.~...~.~ Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions fron property hnes. Give street and block numbers or description according to deed, and show street names and mdicat whether interior or corner lot. STATE OF NEW~FYOR~,~ ./~ ~ c c COUNTY OF ~t ~ ~ ................................................................. be ng duly sworn~ deposes and says that he ~s the applica[ ~Name of indwidual signi, B~ applic, etign) 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 this apphcation, that all statements contained in th~s applicahon are true to the best of his knowledge and belie and that the work w~ll be performed in the manner set forth m the apphcation filed therewith. .S..w..: i.~..t..:.~ .~. r.: ::t:is .~ i'19 ..... ..~...~.:.. ~~....~..~ ......... Notary Pubhc, .~.~~...~Count~ .(Signature of apphcant) I',IOTAR¥ PUB 5,~,te ul d ~v Yor~, '