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Home My WebLink About3290-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE nF OCCUr=A~CY No.. Z2936 ..... Date ......... ~QVe]l~lQ~rl..bt) .... , 19. THIS CERTIFIES that the building located at N~S. Cuater. Ave ........... Street Map No...xx ...... Block No... 7~ ....... Lot No. ~.. ~out)lo~d~. I~.,l~, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 0c.'c ... 2.~...., 19 66. pursuant to which Building Permit No. dated ......... 0et- - 27 ...... ,19..66, was issue~d, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . Pl'~=ate. one. £amilif..dwe3.1J. ng ...................................... The certificate is issued to ~I-?~ lam · De~o sk~ ..... 0wneI, .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .N.~.V.o..(~,. ~1,9~...l~y. ~.,..¥~.~1.2,~ .... Building Inspector 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? 3290 Z Permission is hereby granted to: ............. .~$.~.!~..P..*.~k..s. .............................. to Build new one family dwelling f~..xle~e..A~...se~e.c.t.e.d) .......... //outhald+..Ig.,Y., ............................................................... pursuan¢ to application dated ...................... ..O.~.tc.o..b..e...Z'.......~.. ........... , 19..~.~..., and approved by the Building Inspector. NOTEI minimum setback 3~ft plus. Building I'~;pector ~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at ~7/..9 ~-~L~ ~. (Give ~d location) have been inspected by this department and found to be satisfactory. Dis%rio~ Engineer District Engineer Examined ~ c~ ............................. ..7.. ....... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved ......................................... 19 ........ Permit No ................................. Disapproved o/c ..~....~ ' (Building Inspector) APPLICATION FOR BUILDING PERMIT ..................... INSTRUCTIONS a Th~s application must be completety filled ~n by typewriter or in mk and submitted in duplicate to the Building Inspector. b Plot plan showing location of lot and of budd,ngs on premises, relationship to adjoining premises or public streets or areas, and gw~ng a detaded description of layout of propertymust be drawn on the d~agram which is part of thcs application c. The work covered by this apphcation may not be commenced before issuance of Budding Permit. d Upon approval of th~s application, the Budding Inspector wdl issue a Building Permit to the applicant. Such permit shall be kept on the premises ovadable for inspection throughout the progress of the work. e No building shall be occupied or used m whole or m part For any purpose whatever untdo Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulahons, for the construction of buddings, addmons or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations., (Signature of applicant, or name, if a corporation0) ( dres~of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~'.~ff~.....~..........~......~ ................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer} 1. Location of land on whlhT~roposed work w~ bedT~ M~pNo ..... .~....~.....~...~.. LotNo' ~ Street ond Number ................................................................................................. Municipality 2. State ex~st~ng use and occupancy of prem,ses and intended use and occupancy of proposed construction: o Ex~stmg use and occupancy ........ ._.,.~;r.-.,..-..... ................................................................................................ b Intended use and occupancy .... ,~~ .................................................................................................................... 3 Nature of work (check which applicable): New Budding .................. Addition ................. Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Estimated Cast ........... ,/'....,~..~;~4.. .......................... Fee ........................................................................................ (to be paid on fihng th~s application) .5. If dwelhng, number of dwelhng units ..../ ....................... Number of dwelling umts 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 D~mensions of ex~sting structures, if any. Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stones ............................................................................................................. D~menslons of same structure w~th alterations or addmons: Front ................................ Rear .............................. Depth .............................. Height ............................. ?.Number of Stories '"""*'""~'/~,c:~ ........................ 8 D,mens~ons of entire new construction' Front ....... ~.~......... ...... Rear ...... ~c.x ................ Depth ....~.,.~.....~. ........ Height ............................ Number of Stor~es ........ ./ ................ ~" ,~,// / .t.~.....:.~,,,j'~ ' ~'~'~-- j ',,3 ~'~ 9. Size of lot Front ..../....'7.,~,..~...7../'..._ _' '/ //Rear .... ¢...~..L..__ ............ Depth ...... .~....,Z.q,.~',__~,~ ~ ,// ~, 10 Date of Purchase .... ~..~..~... ............ -- ........ Name of Former Owner .~'.~('-~..~..~¥~~ 11 Zone or use district m which premises are situated ............................................................................ ~ ................. 12 Does proposed construction v,olote q~ ZOnlO~ I,~w, or~d,nance ~r r_egulotjg97 .... ~'....~.~...~...../.~.. 13. Name of Owner of prem,ses ..~?..~ .~.~ress .~.../~...W.~ .~/..~o .................. Name of Architect ..... ~..../...._..~ ............... Address ............................ ..~......~...,P-------~one No .................. Name of Contractor ....~.~:-./..~. x...~c~,~?..:~~'~ ~/~ /~/~' ....... Address .,,~.~..~'..~hone~~~/' -~/~ //~ No .................. / PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exmting or proposed, and indicate oil set-back dimensions fro property hnes. Give street and block numbers or description according to deed, and show street names and ind,ca whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ............................ ~' ...... ~~. .......... ~~. ~ being duly sworn, deposes and says that he is the applic (Name of individual signing application) 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 th~s application, that all statements contained m this application are true to the best of his knowledge and bel and that the work will be performed in the manner set forth in the apphcation filed therewith. Sworn to be~:~ me th~s ......... :", ............... ; ...... ............. ............... Notary Public, ./..~..l~..~....~.~... County (Signature of applicant) No 5z-325J12u Suf,6tk County