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Home My WebLink About3309-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E:ERTIFII~ATE: ElF r'IE:r":UPANI~Y No. Z 28!~ Date . AUg. 22, .. , 1967 THIS CERTIFIES that the building located at H~ywaters Rd. Street Map ~o.assall P°lll~loPc:~:C~o. . Lot No.~3... ~e~o~.,..~,~.~ ....... conforms substantially ~o the Application for Building Permit heretofore filed in this office dated .NOV, .9- , 19 66 pursuant to which Building Permit No. 3309. Z dated Nov [2 ., 19 66 , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is Private o~e. ~mit~ .dw~tt~g ................................ The certificate is issued to ~rthu~. ~us~h ......... 0~e~ ........................ (owner, lessee or tenant) e~ the aforesaid building. Suffolk County Department of Health Approval *~ 2~..1~..~. ~t .~ ..... Building Inspector F~R~ 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) N9 3309 Z Permission is hereby granted to: ............. $.t,, ..,~a,-~ ~ t .....N...Y~, ............................. to .liaJ, l~..~e~..eae...£aa~,~ir..41w~lll~g ................................................................................... at premises located at ..3,0.t..J+g.~.l,..JlJil,~$aU..J)~;J.:~..J?.3L~o~..w,~e~-..D. ............................................ .................................... F,/~..I~y~teve..&l ........... .tta'sst~a~mt ....... "'~'"'t"q'h'..°' 'l~'"e. .................. pursuant to application dated ...................... lJ~'.,.....~ ..................... , 1~6....., and approved by the Building Inspector. Fee ~...0. ~.0...0. ............. Building Inspector $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. ~6~ 2 ! 1967 TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located / (Give ~eed iocation) / have been inspected by this department and found to be satisfactory. Dis%:rio~ Fmgir~e ~;r, District Engineer FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ....................................... , 9 ........ Permit No .......................... Disapproved a/c ............... ~ ......... ................................................................. .. ............. - (Buildi APPLICATION FOR BUILDING PERMIT Date ~ ~ 19~C~ INSTRUCTIONS a. This apphcation must be completely filled mn by typewriter or mn ink and submitted in duplicate to the Building, Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premmses or public streets o areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of thins apphcat~or c. The work covered by th~s apphcatmon may not be commenced before issuance of Buildmng Permit d Upon approval of this application, the Building Inspector will issue 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 building 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 issuance of a Building Permmt pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto describe, The apphcant 6grees to comply with all applicable laws, ordinances, building code and regulations. (S~gnature of applicant, or name, if a corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrmc~an, plumber or bumlde Name of owner of premises ..~.~.~..~.....~..~.~,~.9.~ ................................. If applicant is a corporate, signature of duly,autkorized offi~er.,t jr-) ................................................................... .f..., (Name and title of corporate officer) I Location of land on wh~ch~c' proposed work will, bet done( ~ ~Map, No . .80~ ............... Lot No ................ 40~. Street and Number t.~:.. ........................ :..:z ....................................................................... .. ..... Municipality 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction a Exmsting use and occupancy ...................................................................................................................... b Intended use and occupancy ....................... .o.~.e....f.am.il.~.r ?e.s..i..d?.g..c..e...,.c~...e..1.?z~ ......................................... 3 Nature of work (check which applicable) New Braiding ...~. ............. Addmon .................. Alteration ................ Repmr .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost .2D, DDD., ........................................ Fee ......................................................................................... (to be pa~d on fding th~s apphcat~on) 5 If dwelhng, number of dwelhng units .......... 9g1¢ ............. Number of dwelhng umts on each floor .......................... If garage, number of cars ....... ~I,~'~ ........................................................................................................................ 6. If bus~ness, commercml or mixed occupancy, specify nature and extent of each type of use ........................... 7. Dimensions of ex~stmg structures, ~f any. Front .........................Rear ............................... Depth ................... Height ....................... Number of Stories ............................................................................................................. D~mensions of same structure with alterations or addmons Front .................................... Rear ........................... Depth ................................ Height ................... Number of Stories ................... ! 8 D~mens~ons of entire new construction' Front ...I[0......6-9..I ................... Rear .... .~.~. ................... Depth ..~.~.~..~ ........... Height . ..~..~. .......... Number of Stories ..... o.n.e ................................................................................. 9. Size of lot: Front ...J,Q~A~J. .......... Rear ....... ~°~1,.1 .............. Depth ... 2..T~...~..2.~..0. ........ 10 Date of Purchase ...... ~1~.~.,..~-9.~.6. ...................... Name of Former Owner ...................................................... 1 1 Zone or use district in which premises are situated ............................................................................................ 12. Does proposed construction violate any Tatung law, ordinance or regulation> ................................................... 13 Name of Owner of premises ...&mz+ohu~..P~.q,e~ ...... Address ~..~:zmJ0~Z'gJ4ZO....X'.,~.~t-t~Ohone No ................... Nome of Architect ............................................... Address ............................................ Phone No. Name of Contractor .~.e..~:...E..n~.a.~.d..l-.Io..m. es,..~..n.e... ..... Address ..~.e..~..~.e..h.9..~.~..e.:....S.¢:.~,c~..~.e~bhone No. PLOT DIAGRAM Locate clearly and d,stinctly all braidings, whether emsting or proposed, and indicate oll set-bock d~mensions fror property lines Give street and block number or descnptmn according to deed, and show street names and md,cat whether interior or corner lot STATE OF Nk-'~R~, /~ /] 1, c c COUNTY OF ............................. ~o.~D~]51.a_~z'r>ce ............................. bmng duly sworn, deposes and says that he ~s the apphca~ (Name of indiwdual s~gnmg apphcatlon) above named. He is the ..... oo~t,~o%o~, ................................................................................................................. (Contractor, agent, corporate ofhcer, etc ) of so~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and this opplicotmn, that all statements contained m th~s application are true to the best of h~s knowledge and behef, ar that the work w~ll be performed m the manner set forth m the applmation filed therewith Sw°ro t'° bef°re me this'~'~ /' i'~..~ ~,~i. . .~ da of.~...~...~~ ........ , 19(~{° lqotary Public, State of New/~ork No. 52-1119350 Su~'folk Term E×p~res March 30, l~.J~