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Home My WebLink About3291-zFORM 1~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. I~£1~TII:'ICIATI~ OF OEIEIUPANr.¥ lhTo..~..2..6.8, ff .... Date ............... ~;IPZ'J.Z...20. .... ,19.57 THIS CERTIFIES that the building located at ~OO~e~ .]~..N~rth ......... Street ~as%ern Shores Map Bio ............. Block No ............. Lot No. '9~ .... 0r~rll~:~t¥ N.,~, ....... conforms substantially to the Application for Building Pemit heretofore filed in this office dated ........... QC~; .... 26 .... 19. ~6 pursuant to which Building Permit No...~.. ,~ dated ............ .0.q~ .... ~.., 19..(~ ~vas issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The occupancy for ~vhich this certificate is issued is .. P~ivate..one .f~ily dwell~ng ....................................... The certificate is issued t.o . .~h~¢~l L~de~l ..... ~ek~ ............................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval .. ~¢ 2~. ~6~ · · b~'. R~V~,'t~L~ .... .... . ............ ........... 't~uilding Inspector FOIL~/ NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3291 Z Permission is hereby granted to: ~.~g.t AI31e. r~ ..A~..C Charles ~den to .~d...new..e~..~ly..~e~l~ .................................................................................. et premises located at ..... lo~..g.5.....sac..XII~..~s.te~...8~g.~ ............................................ ..................................... ~/$..Mo.~.s..~..~th.,..,..Greenp~Z ................................................ pur~u~n,t to ~pp~i~tio~ ~t~ .............................. OC.~.~ ....... ~.~., ]~..~.., ~ ~ppro~ by th~ Building Inspector. Fee $..:1L0.00. ......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date FEB 2 3 ~987 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) ~ have been inspected by this department and found to be satisfactory. D~triot ~Z~ct Engineer FORM NO. ?OWN OF SOUTHOLD BUILDING DEPARTMENT · row. C.ER,¢'s O.,CE SOU~.O'O... ¥. E×om~ned C~"~- ~9~ Approved .......................... :.~. ........... , ~.:.: .... Permit No....3....~..L/.........Z~ Disapproved a?c ..~ ........ ................................ 'G~'h'iii~';i~[~"i~'d ................................ APPLICATION FOR BUILDING PERMIT Date .............. .(..~. · ..~........~...~.. ................ , 19 .~ .~.. INSTRUCTIONS a. This application must be completely filled in by typewnter or in ink and submitted m duplicate to the Buildin~ Inspector b Plot plan show~ng location of lot and of buddings on premises, relationship to odloining premises or public streets o areas, and g,ving a detailed description of layout of property must be drawn on the d~agram which is part of this application c. The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Build,ny Inspector will issue a Building Permit to the apphcant. Such permi shall be kept on the premises available for inspection throughout the progress of the work. e. No build,ny shall be occupied or used ~n whole or in part for any purpose whatever unhl a Certificate of Occupanc~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances oF Regulations, for the construction of buildings, addihons or alterahons, or for removal or demoht~on, as herein described. ........ ........... ................................ (S~gnature ~ apphcant, or name, if q~ofporat~on) ~ (Address of applicant) ~ State whether applicant is owner, lessee, agent, architec~2ng,nee~/l~eneral contractor, electrsc,an, plumber or bu,lder. If applicant ~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 ....?~ ............. 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................... b. Intended use and occupancy ......................... ..~..~ ........................................................................... 3. Nature of work (check which applicable) New Building .................. Addition .................. Alteration ................. Repair .................. Removal .................. Dernoht~on .................. Other Work (Describe) ...................................... 4. Estimated Cost ..........~,,~.~ ................................. Fee (to be pa~d on filing this apphcatlon) 5. If dwelling, number of dwelling units .......... ..~'... ............ Number of dwelhng units on each floor ..... ~ .................. If garage, number of cars ................ ~ ....................................................................................................................... 6 If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use .......................... 7. Dimensions of exishng structures, if any: Front ........................... Rear ................................ Depth .................... Height ........................ Number of Stones ............................................................................................................ Dimens,ons of same structure with alterahons or additions: Front .................................... Rear ........................... Depth ................................ Height ....................... Number~,,of Stories ................................ 8. D,mensions of ent,re new construchon: Front ..... .~..?...'. ...... ./..." .......... Rear...............~' Z..... ...... . Depth ...~ ....... Height ...... ~/..~. ......... Number of Stories ..................../. .................................................................................... 9. Size of lot: Front .......... /.,/..~.~. ......... Rear ........./..~..O. .............. Depth .......(.~.~.~ ................ 10. Date of Purchase .................. ~..o...~. ........................... Name of Former Owner 11 Zone or use district in which premises are s~tuated ................................................................................................ 12. Does proposed construchon wolate any zoning law, ordinance or regulation~._ z ...... ~!'"';~z~.' 13. Name of Owner of premises ...(~.~.c,..~ ........ ~,,.c..~/.e...~...Address ...... .%~.~jg.e.f~Z'.~C...SZ ...... ..~.~. Phone No ................... Nome of Architect .................................................... Address ........................................... Phone No .................... Name of Contractor .~..~;~.....~..../.C..~,,5. ............ Address ~u.,~£.~...c..f....~'...~....?.? .~... ..... Phone No ................ PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indmate all set-back &mensions fror property lines. G~ve street and block number or descriphon accardmg to deed, and show street names and indicat whether interior or corner lot. I 4 i ils'- STATE OF NEW YORK, I, ~ c COUNTY OF ................ ........~...,~..J' '~'~' ............ ~ [N~~m of.~li~c~.~.l.~i~r~i~b..~i~.i~.l.,.~t~)~ .. being duly~ -,~/)sw°rn' deposes and says that he ,s the apphca above named. He ,s the .................................................................. ~~ ....................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and f th~s applicahon; that all statements contained ~n th~s application are true to the best of his knowledge and belief; a that the work will be performed ~n the manner set forth in the application filed therewith Sworn to before me this Notary Public,/~.~....~... ~ '"~ ..,.. County,4~-c~ (~ignature of applicant)