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Home My WebLink About3004-z~OI~M i~O. 4 TOWN O1' SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .P. EI~TIFII~.ATE rlF EIP. CUPANP. Y No. Z' '2~3''" Date ................. Sept~ ...... ~.., 19.66 THIS CERTIFIES that the building located at ...l~)]$1~Sel> .I,~.:II~ ........... Street ~9~ic Bay 0ak~ No. . Lot No. 20-.~ .2~ .... ~eeoni~ · · N.~ ..... conforms substantially to the Application for Building Permit hereto~o.re flied in this office dated .......... ~a.~O}.~..~. ..... 196~. pu.rsuant to whi~ Building Per~t No... ~0~' 'Z dated .......... Ma~2O~ .... ~..., 19.66" was issued, and conforms to all of the require- ments .of the applicable provisi, ons of the law. The .o~ccupancy ~or which this certificate is issued is .. p.p.l~ ~$e..on~ · i'~i~'y · d~ O:ing ........................................ : The certificate is issued t.o .... ~Obe~t. ~, 'ViSta' '~v4~;~ ~r .................... ~e e or tenant) of the aforesaid building. ~Suffolk County Department of Health Approval ..... M~y...27..lg66...B~..R,V. ilta .... Building Inspector FORM NO. 2 TOWN OF $OUTHOLD BLHLDING DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREM SES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 300~ z Permission is hereby granted to: .... .Re.be~.t;......~/.JL;t& e. ........................... : ............... .............. ~.~.o..~...e~.....~........z.,~..z..,. .......................... ...... at premises located at ............. : .......................... pursdant to application dai:ed ,. ........ i ................ ~,~0~i.:;...~,..,2..i~:., ~1~.(~, and ~Pr~Ved;by~th~' Building Inspector Fee $~L~e. QO ............ ' : ' ' ....... ..~'.-~..,.~, u.~.. S-9 SUFFOLK COUNTY DEPARTMENT OF HEALTH l~J.d g. Permit ?0 WHOM IT NAY CONCE~I: The sewage disposal facilities for a structure located at '{Give deed location) have been inspected by this Department and found to be satisfactory. District Engineer Distri'ct Engineer FORI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE E×amined ...................................... 19 ........ ~o~d ........................ ~ .~ .............. ~ ~..t....~m~, No..........................~ O O ~ ~..... Disapproved a/c .......................................................................................... :... Application No....~....O..,.~.....~. .......... (Building Inspector) APPLICATION FOR BUILDING PERMIT Dote ................. ........................ .... INSTRUCTIONS o. 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 propertymust 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 por~ 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 regulations. ........................................ (Signature of applicant, or name, if a corporation) ....... i~d ~"~"~'l~'l~ii~ti ......... ~' .................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........ .e..~.~.~. ................................................................................................. i .............................................................. Name of owner of premises .....~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) .~?~.~.~...~., .o...q.r~,ot . o~'~r 1. Location of land on which proposed work will be done. Map No: ................... ~.. No ~ .................. Street and Number .~.o..~./..~...~c.¢~ ..,~..~.ff~...~s.. ................. ~C.o..~.Zf .......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ~&~?.m~ .......... ~. ~s. .......................................................................... b. Intended use and occupancy / ~ .... /v ~¢z,~c-~ 3. Nat Rep, 4. ~-sti~ If 6. If 7. Dir Hek Dim DeE 8. Dirt Hei 9. Size ] 0. Dot 1 1. Zor 12. Doc 13. Nar Nar Nar Locot property Ii whether in ~re of work (check which applicable): New BUilding ..,~' ............ Addition .................. Alteration ....i ............. dr .................... Removal .................... Demolition .................... Other Work (Describe) ........................ i ............. noted Cost '~' ~6~, ~ ~ c~ . (to be paid on filing this application) I If d~velling, number of dwelling units .......... ~ ................ Number of dwelling units on each floor .............. i ............. ~rage, number of cars ............................................................................................................................. i ............. usiness, commercial or mixed occupancy, specify nature and extent of each type of use .................. i ............. msions of existing structures, if any: Front .......................... Rear .......................... Depth .............. i ............. ht Number of Stories ........ ' ........... ,=nsions of same structure with alterations or additions: Front ................................ Rear ............................... .............................. Height ............................... Number of Stories ........................................ ,~nsions of entire new construction: Front ~7 ~r ~),, ............................ Rear ~'7~ o Depth ht ............................ Number of Stories or use district in which premises are situated .................................................... .~.~, ........................................ proposed construction violate any zo, ning law, ordinance or regulation? ......... .~....O.: ................................... le of .~. ...................... : ............................ ~ddress ............................................ Phone No.~..ff.: ?' ~e of Contractor .................................................... Address ............................................ Phone No ................. PLOT DIAGRAM r clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensi )ns from ~es. Give street and block numbers or description according to deed, and show street names and indicate erJor or corner lot. STATE OFI N EWr~OJ~I~. COUNTY )F ~....~..k~..6K..,(,.cm.,..,.~ ...... above nar of said ow this applic and that t .~. ............ : .............................................................. ee ng duly sworn, deposes and says that he is the ~pplicant 4ame of individual signing application) .~d. He s the (:~. ...................................................... (Contractor, agent, corporate officer, etc.) ~er or owners, and is duly authorized to perform or have performed the said work and to make and file ~tJon; that all statements contained in this application are true to the best of his knowledge an belief; ~e work will be performed in the manner set forth in the application filed therewith. Swornto eforemethis j~ ~ j~ /x~ ..................... of ................. , ! '(/ / j ..... ......... ................... Notary Pu~lic~.~,.~.....~~., ~unty~ ~ (Signature of applicant) / ~/ ~ JUDITH T, BOKEN F R O M T H £ O F F I C £ O F CHARLES A. WOOD, R.A. A R C H I T E C T NORTH COUNTRY ROAD WADING RIVER, NEW YORK PHONE 929-4310 E E_, VI' L L A PLAN NO~::~::~ S & I THIS' PLAN IS THE PROPERTY OF THE ARCHITECT AND SHALL NOT I~E IDUPLIC;&,TEO WITHOUT HIS PERMISSION SHEET NO. CHARLES A. WOOD, R.A. / , SCALE CHARLES A. WOOD, R.A. ,~ NORTH COUNTRY ROAD WADING RIVER, NEW YORK P H O N E 9 2 9 - 4 3 I 0 6 H A R L E S A. W O O D, R.A. ~%;~;;:,~'*, DRAWN BY DATE N O R t H C O U N T R Y R O A O .~ ' ~i '''~ r '." ~' CHECKED BY let REV. NO. ' ' ., r r o m ? . E o r r m c ~ o r .~O~'~~<~ ~ ' PLANI~u~'~. xs4] SCALEY4""= SHEET No. CHARLES A. WOOD, R.A.~¢~'- '""'~ PHONe 92 ~ 43tO /