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Home My WebLink About3252-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EIERTIFIEIATE OF OBEIUPANEIY No.][ 276[[ . Date ..A~lSt 2 ,1967 THIS CERTIFIES that the building located at ~/~, ~}~*d~S I~ .. Street Map No. :~ Block No.IK~ Lot No. ~ . ~t;ho~.d! t~:~¥ ~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated - {~ .3 , 19~ pursuant to which Building Permit No. 32~2.Z dated OCt ~ , 19~6 , 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~.V&~e .~18 :~all~t],y. d~4~; ~ ~g. ............................. The certificate is issued to ~'.ar~..~..P~..~I~.~.. ......... .~;~I~1~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ~Tlll~y ~l~ ~l~. ................ Building Inspector ~ FOEM l~'O. 2 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) N? 3252 Z Dote ....................... 0~t,O. tle~ .....~ ......... , ]9..66. Permission is hereby granted to: ...(~..~Sa.tt.h..&..S~rm..Z~.....~.¢....~a~ae~ p. ~ ............... ~.o.~.t3o;l,d .............................................. to ....~...$.~-.(~..11e~..~le...~a~ill~...dwall/~g ................................................................................. at premises located at .,.~./..~.......~..a..~..d..~..e.~...~..~ ............................................................................. ........................................ S.o..u...t..h..9..l..d.. ~ .....~..,.~., .................................................................................... pursuont to application dated ....................... .~..~.~.~.~.~.....~ ............ , 19..~16., and approved by the Building Inspector. Fee $~,0~00 ............ I/ Bu Iding nspector/ s-9 SUFFOLK COUNTY DEPAF~MENT OF HEALTH Date Bldg. Permit No..~ ~ ~ ~ 2_ TO WHOM IT MAY CONCERN: The sewage disoosal facilities for a structure located at ( G~ive deed location~ ~ have been inspected by this Department and found to be satisfactory. ~ District Engineer District Engine FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined ......~........~.. ....... , 19~........ J~ Approved ................. .~: ...................., 19..~ ....Permit No. ~.....~....~....~.........'~ Disapproved a/c .............................................................................................. Application No. ,.~.,.,.,~...,~,,...~... ...... APPLICATION FOR BUILDING PERMIT Date ...,.~,.,...~-.~ ......... ~ ............................. . 19....~....~,.. INSTRUCTIONS o. This opphcotion must be completely filled m by typewriter or ~n mk and submitted in duphcate to the Buildin, Inspector. b. Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets o areas, and g~ving a detaded description of layout of property must be drawn on the diagram which is part of th~s apphcat~or c. The work covered by this application may not be commenced before issuance of Building Permit. d Upon approval of this apphcation, the Building Inspector will issue a Building Permit to the applicant. Such permi shall be kept on the premises available for ~nspection throughout the progress of the work. e. No building shall be occupied or used ~n whole or m part for any purpose whatever until a Certificate of Occupanc shall have been granted by the BuHdlng Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demohtion, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (S~i~oture of applicant, or name, if a corporation) (Address of ~'~'~'lica~[~l State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ..................... ............................................................................................................................. If applicant ~s a corporate sign ure of dui authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done .Map No~....r~..~.~.../~......~.x~...~.../~.... Lot No.: ........................ Street and Number .~...~..~...'Z-~.....'~..(~...~.. ...... ..~..~..~..~../.~...~..~.~....C~.4~../~'.~. ... ~.~....~....7~...,~...~...~....~...:...~/~..;~.. ........ Mumcipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~...~..r.~...~..7--- b Intended use and occupancy .../~....~..~..~ ..~....~...~/..~....~.. ....................................................................... 3 Nature of work (check which applicable): New Building .... /~ .......... Addmon ................. Alteration ............ Repair .................. Removal .................. Demolitiar~ .................. Other Work (Describe} ...................................... 4. Estimated Cost .....~.~/..~..~. .................................... ~ee ........................................................................................ (to be paid on fJhng th~s apphcahon) 5. If dwelling, number of dwelling units ..... O..,,f(~_,~., .......... 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. D~mensions of existing structures, Jf any' Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories .......................................................................................................... Dimensions of same structure with alterations or additions. Front ....................................Rear ....................... Depth ................................ Hmght ............................ Number of Stories ......................... 8. D~mensions of enhre new construction: Front ~ j Rear ~'¢~ Depth Height ..../....~. ........... Number of Stories ..... .~.....~.....~:.. .................................................................................. 9. S~ze of lot: Front ..../....~..~: .............. Rear .... /.. ............................ Depth ....~..~..o. .......... 10. Date of Purchase ................................................... Name of Former Owner~;~.~'...~..~..~..¢~..~...~.¢.~,,)....~..~..~..~... ...... 11. Zone or use dmtrict in which premises are s~tuated ...... ..'5~....~....¢.: ................................................................... 12 Does proposed construction violate any zomng law, ordinance or regulahon~ ....~...~.. ............................................. 13 Name of Owner of prem~ses-~.x .~,..,~...~....~....~.. .............. Address ............................................ Phone No .................. Name of Architect .................................................... Address ............................................ Phone No ................... Name of Contractor~.-~.~..'¥?...2T.~....~...~...~..~...~. ............ Address .~..7-...~..~.~..~ .................. Phone No. ~...~...~... ..... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and ~nd~cate all set-back d~mens~ons fron property hnes. Give street and block number or description according to deed, and show street names and ind~cat~ whether interior or corner lot. STATE OF NEW YORK, ~, c.c. .~.~ .N..~::~ ........... be,rig duly sworn, deposes and says that he is the applicon (Name of mdwidual s~gning apphcahon,~ above named He ~s the ...... ~.~-~ ................................................................................................. (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fd this application; that all statements contained in this apphcat.on are true to the best of h~s knowledge and behef; an that the work will be performed ~n the manner set forth m the apphcation filed therewith. Sworn to be ..~ .~... fore me thiSday of ~ ..t~.. 19 ~ <, ~~--~ -"~'~ Notary Public, .z.(.J.~....~.,~~ ....... C~unty (Signature of applicant) ' ~ ~' ~'u',¢ ~ %~,,~ ~/ _//. . ~ ~ ~OTAq~ Y~. l . ~a~ z, ~,~ York ~ ~o 52 32~.1Z,1 5~,;~1',~ Coun~ ~ ~p~res Mard~ 30, 19~7