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Home My WebLink About2985-zFORM 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CL~-RK'S OFFICE $OUTHOLD. N. Y. OE[~TIF~r.~TE QF oor. u[~Nr.Y No. 2~. ~:~8. .... Date .................... ~)mpt;~.. ~., 1966. THIS CERTIFIES that the building located at 1~/~. · ~Oll.rldt. 1)1~rO .......... Street M~ern Shores Block No ............. Lot No. 19, .... Gree~or.t, .N,Y.,.. conforms substantially ~o the Application for Building Permit heretofore filed in this office dated ............. EebB~a~.~19.66. pu.rsuant to which Building Permit No. 2~8~.. dated ............ Fe~...~, 19~., was issued, and conforms to ali of the require- ments .of the applicable provisions of the law. The .occupancy ~or which this certificate is issued is ...P~va.~e. ore..~a~ .~t~.~ ........................................ The eex%ifieate is issued ~o .. H~. & .~ .E~i~. · ,~e~ ....... ~O~ .............. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval . .A~%...~. ~.. by. ~,. ~.. Building Inspector TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N. Y. BUILDING;PERMIT (THIS PERMIT MUST BE K~PT ON 3'HE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2985 Z Permission is hereby granted to Building Inspector Fee $.~[O.~)O..l:~..oh~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No. '~O~6 TO WHOM IT MAY CONCERN: at The sewage disposal facilities (Give deed location)/ for a structure located have been inspected by this department and found to be satisfactory. District Engineer FORM NO* I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ P~r,~it N ... Disapproved a/c ............................................... ~~~.. ......... ..,.~ .~Z.~, ......................... .~ ......................... ................... ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be,complet~ely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must 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 Building 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 Deportment for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, fo~ the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant'agrees to comply with all applicable laws, ordinances, building code and regulations. N~isty. Acres Ino, (Signature of applicant, or name, if a corporation) Old Field Head, Setauket, ]~.'Y. 11785 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Builder Name of owner of premises l¥~r. & lv~rs. Eili¥ ~. Nor~ik If applicant is a corporate, signature of duly authorized officer. ~res, (Name and title of corporate officer) ~tap of Eastern Shores 1. Location of land on which proposed work wilt be done. Map No.: 4021 Lot No.: 19 Street and Number .......... R.9..~.~...g..zT.~..¥.e. .......................................... gz'.fl.e.nD.ct~.~ ................................................. Municipality 2. State existing use and occupancy of prernises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... i family dwelling b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. Addition .................. A~e~;~tian ......... ,(/.i ..... i[Repmr .................. Removal .................. Demolitian .................. Other Work (Describe) ........................................ ~20, OOO ~10 . 4. 5stimoted Cost ............................................................ Fee ......................................................................................... (to be paid on filing this applicatiq~) 5. If dwelling, number of dwelling 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. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................ . ................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ................. ~.r.~mber., ~ of Stories ..... ~, ............... 27t8" 8. D~mens~ons o~ entire new construction: ~[omt ... ................ ~ ............... Rear g. S;ze o[ ~ot; Fro~t ............................ Rear .................................... Depth ............. ]0. D~te o~ Purchase ........................................................ ~e o%~~ ] ]. Z~me ay use d~str~ct ~m which premises ~re sffuated ............................................. ~ ................................................... ]2. Does p~oposed cons$ruct~om violate aay zom~n9 ~aw, ordinance or ~e~u~at~on? ............................................................ ]3. Name o[ Owner o[ premises ........................................ ~aaress ............................................ Phone mo ..................... ~ame of Architect ...................................................... Add,ess ............................................ ~boae ~o ..................... ~,~ ~8 ~, ~.. O~le~d ~ad 751- Nome of Contractor .................................................... ~aares~~..~.y; ............ Phone No. '"~'70 ........ PlOT DIAGRAM Locate c~early and distinctly a~l buildings, whether existing or proposed, and indicate all sef-~ck dimensions from property I[nes. ~Jve street and block number or descripfio~ according to deed, and show street names o~d indicate whether iaterJor or comer lot ,i .................................... ... ........ . ......... , ....... ........................ .'. .......... being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) ~7l~11~,~11~i- O.f ~.1~,~ above named. He is the ............................. ; .................................................................................................. ; ........................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duiy authorized to~ perform or have performed' the said Work and to make and file this application; that all statements conta,ined in this oppli6ation are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ,,~ ~ ........... ......... , // .............. nz ..................................... No ry.,~v~l~c,~,~.~..~. ~ County //~nature of applicant) t~gtar~ tmm,~, ~;t~:de of New York ~9' 52-~)80900, Suffolk County / '~em t~xpn'e:~ Mm*ch 30, 19 ~ ~ ,i / L J, I