The URL can be used to link to this page

Home My WebLink About3243-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE ElF EIIglgUPANBY No. II ~ Date THIS CERTIFIES that thc building located at Map No. ~ Block l~o.:lt:~ Lot No. 0et~obe~. 10,19 6?- W/I~. l~Ia,-,l~ol, Lm__~l~ Street xlt ¢lltcheglle ~ I~ ~v,~ ....... conforms substantially to the Application for Bmld~ng Permit heretofore filed in this office dated l~ept: 30 ' 19 615 pursuant to which Building Permit No. 32t~ dated ttep~, 30 ,19 ~6, was ~ssued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued ~s ~i~t~ o~.fam~y. ~[i~g ........................... The certificate ~s ~ssued to ~o~ ~ ~,~.. ~ner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~.a.~.~'~ ~ ....... , .... I ........ Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT~tOLD, N. Y. ~ -~ BUILDING PERMIT (THIS PERAA(T MUST BE KEPT ON THE PRF_AAISES UNTIL FULL COMPLETIOn4 OF THE WORK AUTHORIZED) 'Permission is hereby granted to: ................ .......................................... to ~.~.~...~L~.. ,g~,....~ll~Z...l~.~ ~,~-~. I ................................................................................... at premises located at .~.~....l~t~O~...~ .................................................................................... ............................................ ~'~t~ _n~p~et..~:,~., ................................................................................ pursua~¢ to application dated ......................... ~Jo~.t, ....... ~ ............. , 19..~., and approved by the Building Inspector. Budding Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. ~J6 2 ~ ~967 TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) f~ have been inspected by this department and found to be satisfactory. Distrio~ Engineer District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. Approved ........................................ , 19 ........ Permit No ................................. Application No. ~o .~- L( ~ Disapproved a/c ............................................ APPLICATION FOR BUILDING PERMIT Dote ..... ~ ......... ..~....O....~ ..................... 19..~..(~,.. INSTRUCTIONS a. Th~s 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 buddings on premises, relationship to adjoining premises or public streets or areas, and g~ving a detailed description of layout of propertymust 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 Buildmg Permit. d. Upon approval of this application, the Building Inspector will 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 Department for the issuance of a Building Permit pursuant to the Building Zone Ordmance 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, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. ...... · ......... w (Address of applicant) State whether apphcant ~s owner, lessee, agent, architect, engmeer, general contractor, electrician, plumber or builder. Nome of owner of premises ........ ~.,..~ ...... ~ .................................................................................. If applicant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No .............................................Lot No: .................... Street and Number ...~./.~....~.~.....~ ....................... ~..~.~..~...~ ...................................... Municipality 9. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a Ex,st,ng use and occupancy ............ .~..~ ........................................................................................... b Intended use and occuponcy .................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4. Estimated Cost ...... ~..¥..~.~..¢~ ................................... Fee ......................................................................................... (to be pa~d on filing th~s application) 5. If dwelhng, number of dwelhng umts ............................Number of dwelling units on each floor ........................... If garage~ number of cars .......................................................................................................................................... 6 If business, commerc;al or mixed occupancy, specify nature and extent of each type of use ............................... 7. D~mensions of ex~sting structures, if any: Front .......................... Rear .......................... Depth ........................... Height ........................... Number of Stones .............................................................................................................. D~mens~ons of same structure with alterahons or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8 Dimens,ons of ent,re new construction: Front ............ ~. ............. Rear ......... f-.~ .............. Depth .-~.~..... ',~'~..~ He,ght ............................ Number of Stories ........... ./. ............... 9. Size of lot. Front ...... i~.~..~. ............. Rear ......... ~.~] .........Depth ......... L..~.~..: ............. 10. Date of Purchase ...... ..~..,~.. ........... L.?.fi..(-.. ..................... Name of Former Owner .~ ...... 11. Zone or use district in which premises are s~tuated ................................................................................................. 12 Does proposed construction viQlate any zoning law, ordinance or regulationP ...................................................... 13 Name of Owner of prem,ses .~:~.~,.~..Address .... ~.,.Z~..' ..... Phone N o./~..~'.. :. .~. . .-. (, ~. ,~. Name of ............................................ Architect ..................................................... Address Phone No ..................... Nome of Contractor .~.....~......~ ...... Address ~,~ ~ .~... P~one No.P..~...':.~..:..G./.~..~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions from property hnes. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. i STATE OF NEV'~YO~,~,. COUN~ OF ~~ ....... , ' (~ame of mdwidual s~gnmg app ~cot on) above named. He is the ....... ~t~:Z.: .......................................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and fife th~s apphcot~on; that oil statements contained m th~s application ore true to the best of h~s knowledge and behef; and that the work wdl be performed ~n the manner set forth in the apphcohon filed therewith. Sworn to ~fore me th,s ~4.,~~~,. ~ ~l ~ ~ __ ~ ~ .~ .........~<CK.,...~..L~ .............................