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Home My WebLink About3273-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. r-EIBTllrIOAT£ OF oor. UPANr. y I~o. Z 2682 Date .... .A]).1~.$l .~ 19~.. THIS CERTIFIES that the building located at . .~/.I~l. 8o~xth. l~rbor. 1~1 .... Street Map No...~X~ ...... Block No .... ~ ..... Lot No. .~. ...... .~.O..~.~.h..O.l.~. .... .1~.~.~.: .... conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated .............. 0t~oher. ~ 1966. pursuant to which Building Permit No. 3~3" 'Z dated ............ 00tObe~ '1~ 19'66, was issued, and conforms to ail of the require- ments .o£ the applicable provisions of the law. The .occupancy ~.or which this certificate is issued is ...~?.l.??.~..e. ?..~.e...~.a.?.i,.~.y..dW~.!.~..~_qg ...................................... The certificate is issued t,o . ~'~P,~h&~.Mo~t;g~ll~l'~; ..... .(~ ..................... [owner, ~essee or tenant) of the aforesaid building. Suffolk County Department of Health Appr. oval .~.~.~.. 1~.~ 1~ . b~. ]~ .Vl~ll,~I~ ..... FORM NO. 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? 3273 Z Permission is hereby granted to: .... .~.~ ~.~.. ~.~g...~...~.O~ .t~.... A~..~.. ~hard ¥,ont gomery ........... ~.~.~ ................................................. to . .~lCI.. ne¥...one.. £amll.~...dw. ellX D.g .................................................................................. ct premises located at ...H/~.....~outh..Ha~hor..Road .................................................................... ....................................... ~olA~hQi~../~I. ....................................................................................... pursuan¢ to application dated ......................... O.¢t.~D. be~.....6 ........... , 19..6~.., and approved by the Building Inspector. Fee $..~,Q,,.QQ .......... ---~ Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date JAN Bldg. Permit No., TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. D2 a £~'lC~D ~i~ e~t Engineer FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .... ~..!...~.. ............ 19...~...~.. Approved ........................................ , 19 ........ Perm.t No......... ~'~ ~ ..... '-~..... ..... ~........7- - D~sapproved a/c ..~~......~ ................. ...................... (Bu'i~i~i ................................. APPLICATION FOR BUILDING PERMIT Date .................. ......................... , INSTRUCTIONS a. Th~s application 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 public streets c areas, and gwmg a detailed description of layout of propertymust be drawn on the d~agram which is part of th~s applicatio~ c. The work covered by th~s applicahon may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector w~ll issue a Building Permit to the applicant. Suc 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 m part For any purpose whatever until a Certificate of Occupanc shall have been granted by the Buddmg Inspector APPLICATION IS HEREBY MADE to the Building Deportment 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 c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The opphcant agrees to comply w~th all applicable laws, ordinances, budding code and regulations. (Signature of apphcant, or name, if a corporation) (Address of applicant) State whether opphcont is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde. ....... ........................................................................................................................................................ Nome of owner of premises .... ...~...'..~..~.~.4~.~.,~P ......... ..~..~.~.'.~.~.~-~....,~......'~..~.. .................................................................. If apphcant ~s a corporate, signature of duly authorized officer. .......... ...... ...... ....... // (Name and t~tle of corporate officer) 1. Location of land on which proposed work will be done. Map No ............................................ Lot No: .................. Street and Number .... ~.~.~ ...... ~.~...~....~.~....~ ................................................ Municipality 2. State ex~sting use and occupancy of premises and intended use and ~cupancy of proposed construction: o Ex~sting use and ~cuponcy ................................................................................................................................ b. Intended use and occupancy ... ~.~.~ .......................................................................................... 3~ Nature of work (check which applicable): New Building .... ~ ......... Add~hon ................. Alteration ..~ ......... ~ .... Repair ................... Removal .................... Demohtion .................... Other Work (Describe) ..................................... 4. Estimated Cost .... ...-~..../.~f~-/:O.,~-,~ ............................ Fee ...... ~Z'.~..~....~?.. ...................................................................... (to be pa~d on filing th~s application) 5. If dwelhng, number of dwelling units ........ ./. .................. Number of dwelling units on each floor ....... /.. ................ If garage, number of cars ..... /,Z.~/,/.~.~. ...................................................................................................................... 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D,mens~ons of ex~shng structures, if any: Front ..........................Rear .......................... Depth .......................... Height ......................... Number of Stories ............................................................................................................. D~mens~ons of same structure w~th alterahons or add,boris: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8 D~mens~ons of enhre new construchon: Front ..... .~.(~..~ ............ Rear ......... .'//..~..~ .......... Depth .....~..../. ........... Height ........ /.~...:. ............ Number of Stones ....... ./. ................... 9 S~ze of lot: Front .... ,/~rfi'..~ .............. Rear ....... ZE.~..'. ........... Depth ....,,~/..~..~. ................. 10. Date of Purchase ..... :.-. ................................................ Name of Former Owner .../~....,:~........~.:......Z...~.T.~....."~. .................. 11 Zone or use d~strfct m which premises are s~tuated ....... . .7~..~../.~/.~-¢../~..~.~...~..-~.. ........................................................ 12 Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13 Name of Owner of premises .~.,..../~....~....~.O..~..'~...~..-~..~......Address ....~...~?~'..~¢f...¢.~.P. ..................... Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor (~;~,~sz~..~'.l~.....~..~..~'..~...~.¢../I,~....Address ....o..~y/,: ..?~....c~....~.. ..................... Phone No.~.~.;~-.Z.z..~...~.. PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro, property hnes. G~ve street and block numbers or descnphon according to deed, and show street names and indica~ whether interior or corner lot. STATE OF NEW YORK, } S.S. COUN~ OF ................................ ...... ~&~.....~..~.f~ ...................................... being duly sworn, deposes and says that he is the applic~ (Name of individual signing applicah~n) above named. He is 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 f th~s application, that all statements contained ~n this application are true to the best of his knowledge and bali. and that the work w~ll be performed in the manner set forth in the applicahon fried therewith. Sworn to befoze me this .......... Z~ ......... day of ...... Notary Pubhc, .~/~.~.....~.¢.....~q~:.~:~...~. County ~ (S~gnature of applicant) No 52 3233120 Suffolk Cou~ Term