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Home My WebLink About2992-zFOICM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT '1'OWN C~ERK'S OFFICE SOUTHOLD, N. Y. P. EI~TIFIP. ATE E}F E3E:~UPAN~.Y THIS CE~RTIFIES that the building located at .Ed.~.S. & .~flra;~; .Road ....... Street Map No .... ~X~X .... Block No .... X~ ..... Lot N~ ...... ~thO~ff~.. ~,~a ......... conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated ........... ~eh..~6. [.., 196~. pu.rsuant to which Building Permit No. ~.92. g. dated ........... Eeb...16. ..... 19.~6., was issued, and conforms to all of the require- ments ,of the .applicable provisions of the Mw. The .o,ccupancy for which this certificate is issued is ...~Pi.UatO. 0~. ~a~y. d~l~ag..~ith. · 2n~ .apartl~e~t .on .ap.pro. al (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval., '~e'' '~' '~6'' '~ .R.~.Vi~I~ .... Building Inspector FORM NO. 2 TOWN OF SODTHOLD BUILDING DEPARTMENT TOWN CL~:RK'$ OFFICE SOUTHOLD, H. Y. BUILDING P[RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2992 z Date .................... ~-b~L~'a~'3r....-~L6 ........... , 19. ~6. Permission is hereby granted to: .................... C¢~;¢h~u~ ...................................... at premises located at ...... .~el.'~,~...Rc}..&..Stt~}.¢...R~ ....... (~drctlm...(~.])i~¥~.;.) ............... : ............... .............. : ....... ................... 6~'~h~Id'~'"'--N'~'Y'~ ....................... ~ .......................... ~ ................................ ......................... ,.~ ........... ~.. ......... ,....~ ......................... ; p~rsua.t to apblication doted. .......... : ......... :....i..Fe~;....~6 ................ 196~..i; ~ ' :' and.diSprOved by the~' · Building Inspector NO~ Pe~mi~ m~Jeet to action of ~d/A~PeAi~ ~/~/6~ Fee $..,1,O',OO..~ ...... s-9 SUFFOLK COUNTT DEPARTMENT OF HEALTH Date Bldg. Permit NO., ........ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ..... ~ ,~_~,,~~~ ..... have been inspected by this Department and found to be satisfactory. D£~tr~t Engineer FORM ~0. 1 T~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. Approved ........................................ , 10 ........ Permit INa ~ ^PPL'CAT,ON BU"D,NG PERM' Date ...... .................................. iNSTRUCTIONS a. This 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 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 p~rt of this application. c. The work covered by this application may not be commenced before issua.nce 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 Department 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, for 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 regulatiaps. .................. ...... ............ ............ State whether applicant is owner, lessee, agent, archit~g,t¥ engi.neer, general contractor, electrician, plumber or builder. ........................ ................................................................. Name of owner of premises ................ R? .................................................................................... If applicant is a corporate, signature of duly authorized Cfficer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................bat Ng,: ........................ Street and Number ....(:g..':-,/., ...... '~ '~ "--'~---- ~c.'.~..:~...,...~'..~r~...~...-~.~...,..~.-..~4rx..'nff.....~.'./., .~..~...~..:' ............... '~ ~'~.~.~..~;.:.~.. ....... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ................................................................................................... .~ .~..,...~/.~¢~r~ 3, Natu.e work (check which applicable): New Building Addition Alteration ...... Repa r .................. Removal~ z/~-'r~'i ................ Demolition .................. Other Work (Describe) ............................ ij ........... 4. Cost ................ ............................ Fee .............................. 5. If d~elling, number of dwelling units ............ ¢ .............. Number of dwelling units on each floor ............. I .......... If ga 'age, number of ~rs ............................... ~ ........................................................................ ~ ........................ j ............ 6. If bt siness, commercial or mixed occupqncy, specify nature and extent of each type of use ................ .J ............ 7. Dime nsJons of existing structures, if any: Front ............................ Rear ................................ Depth ............~i ...... .. Heig Number of Stories ...................................................................................... Dim~ ~ions of same structure with alterations or additions: Front ....................................Rear ................ , ............ Dept ~ ................................ Height ............................ Number of Stories ................................. 8. Dim, ~sions of entire new construct on: Front . ~..~ ...2 ................... Rear ...... ~.. Z . Depth ...~.~....~ .......... Heigqt ......~) .......... Number of Stories ......................................................................................................... : ............. 9. Size of lot: Front ........ /.~..~ ........... Rear .......... J.~.~ ................ Depth ....... ~.~)Z~ ................. of Purchase ............ ~ ........... ~.~.~. ............ Name of Former Owner ........................................... 10. Dat~ ~ 11. Zon~ or use district in which premises are situated .............................................. ~. ........../.~ . / t ~,: ............................. ~ ............ 12. Doe )roposed construction violate any zoning law, ordinance or reguJation~y. Ce...z.~.q4..~J~?~.~...~.~K~.~ ...... 13. Nar of Owner of premises ...~ ....... ~.~.~-.~....Address ~..~t~..~..~...~.~.~,.. Phone ~..[~...~..~.~ Naw of Architect ...................................................... Address ............................................ Phone No ........k ............ Na~ of Contractor .~ ........ ~ ............................ Address ~'u~'ne$ ~ ~'~'~. Phone No. ~ PLOT DIAG~M Locate :learly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensi~,ns from whetherPr°per~y intli~'eS'~rior GiVeor cornerStreetloland block number or description accordingl~_to deed, and show strm names and indicate STATE OF NEW YORK, ~ S S COUNTY OF ........................ z~.~..~ ' ' .............. ~ ............................................... b~in~ duly sworn~ deposos ond soys tho~ he ~s the 6ppl~cont (Nam0 of individual signing application~ fi/). above nan~ed. He ~s the ................................... ~...~ ........................................................................... ~ .............. (Contractor, agent, corporate officer, etc.)[ of said o~ner or owners, and is duly authorized to perform or have performed the said work and to makei and file this application; that all statements contdned in this application are true to the best of his know[edge and belief; and that the w ~rk will be performed in the manner set forth in the application filed therewith. / Sworn to b ~fore me this ,~ ,~ ......... 4.~ ....... day of .~~....., 19.~,~.. ~ , ~Z . J Notary Pu)lic, ~~~~oun~ff (~ture of applicant)