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Home My WebLink About3292-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIEIATE FIF EIBEIIJPANEIY No.~, ~ .. Date ~r 3 ,196~. THIS CERTIFIES that the building located at l[a,)~&~el',s ~ Street Map N~a~ Pt Block No ~ Lot No. 3~ ~ho~.. ~,~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... 0~ . .~ , 19 ~ oursuant to which Building Permit No. .$~2.Z dated ~ . ~ , 19 ~, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificale is issued is p~ one..f~i~y .~well~g ................................... The certificate is issued to Z~Sllee. ~ .......... ~ ........................ (owner, lessee or tenant) of the aforesaid building. S~olk County Department of Health Approval ~e .19,. 19~..bF. A,. 1~la FORM 1~10. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3292 Z V~e ................. ~....O~t~be= ....... ~....., ~.~.. Permission is hereby granted to: to .... bu&l~ ..~ev..e~e ...f.a~$.l.;y.. 4v®~.t. -~u~ ............................. :...: .............................................. at premises located at .....~O~...N&.s$~u-..Pe~n~;-..Pr&p ................................................................... ................................... Ha2nrat~z~s· 't~d ......... gu~ceho &~te ................. ................................................ pursuan¢ to application doted .............................. 0.~ ......... ~6 ........ , 19..~., and approved by the Building Inspector. Fee $...%0~ ......... Building InspectOr S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date JUN ~ 9 ]96? Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at,,, / (Give deed location) have been inspected by this department and found to be satisfactory. YO~M NO. 1 Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOP. BUILDING PERMIT Date .......... ...... ................... (, INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duphcate to the Buildin, Inspector. b. Plot plan showing locat~on of lot and of buddings on premises, relationship to adjoimng premises or pubhc streets c areas, and g~ving a detaded description of layout of property must be drawn on the d~agram which is part of this applicatior c. The work covered by th~s application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will ,ssue a Building Permit to the applicant. Such permi shall be kept on the premises available for inspection throughout the progress of the work. e. No budd,ng shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Bu,ld~ng Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulahons, for the construction of buildings, additions or alterations, or for removal or demolmon, as herren descnbec The applicant agrees to comply with all apphcable laws, ord,nances, build,ng code and regulations., .c fl (S,gnature of appl~/ant, or name, if a corporation) ........ '" State whether applicant is owner, lessee, agent, architect~,~?jg,neer, general contractor, electr,cian, plumber or builde Name of owner of premises..I ........... %/_ ~ . .~ ......... ~i:(~/ If applicant ~s a corporate, s~gnature of duly authorized offic (Name and title of corporate officer) 1 Location of land on which proposed work w,II be done Map No ./'~-~...~:~r...~. ..... . Lot No' ...3..O...~.. ...... Street ond Number ............................................................................ 2 State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction' o Ex~sting use and occupancy ........................................................................................................... b. Intended use and occupancy ............................. ~...~ ................................................................. 3. Nature of work (check which applicable). New Budding .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demohtion .................. Other Work (Describe) ........................................ 4. Estimated Cost ........~.~./~..~ ................................... Fee ........................................................................................ (to be paid on filing th~s application) 5. If dwelling, number af dwelling units ................~ ......... Number of dwelhng 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, if any: Front ........................Rear ................................ Depth .................... Height ........................ Number of Stories ........................................................................................................... Dimensions of same structure with alterahons or addmons Front .................................... Rear ........................... Depth ................................ Height ...................... Number of Stones .............................. 8. Dimensions of ent,re new construction. Front ............. Z.~..~. ............ Rear ..... Z.;).~ ............... Depth ..... ~../. ............ Height ......... ./.~. ...... Number of Stories ....................../. ................................................................................... 9. S~ze of lot' Front ..... ./.P....~. .............. Rear ............. //dO ............... Depth ..........~.1../.~...'~'. ....... 10. Date of Purchase .................................................... Name of Former Owner ...................................................... 11 Zone or use d~stnct in which premises are situated 12. Does proposed construction violate ,any zomng law, ordinance or regulation:) ......... ~ ....................................... 13. Name of Owner of premises ...h/.~;~.~..c.~......~'..~'q.r~7-- ...... Address ................. t'~ ......................................... Name of Architect ............................................ Address ....................................... Phone No ................... J Name of Contractor ...~.~...e.~.. ..... ~...~.Z~(.,.~ ........ Address .4~'~..u..~..~..~...~..S....~.<...C~.~../~...... Phone No ....... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex,sting or proposed, and ~nd~cate all set-back dimensions fror property hnes. Give street and block number or descnphon according to deed, and show street names and ind~cat whether interior or corner lot t(70 'L_ STATE OF NEW YORK, COUNTY OE ............................... ~'"' .............. ~ ............. ~ ............... ~i" being duly sworn, deposes and says that he Is the apphca, (Namer ind~wdual s~gnlng apphcatlon) above named. He is the ........................ ~.~ ............................................................................................ (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and this application; that all statements contained m th~s application are true to the best of his knowledge and behef, that the work will be performed m the manner set forth m the application filed therewith Sworn to before me this .......... ~:~"7'""~ day of .... ~ ........ , 19..~...~. Notory Pubhc ... Coun~'jl:C"'/-°u"~"~ignature of apphco;~) ..................... No. 52-0618100 Suffolk County ,' v Commission J~res March 30, 19