The URL can be used to link to this page

Home My WebLink About3041-zFORM 1'~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. P. EI~TIF'II~ATE OF 131~UPANP.¥ No.. ~ .2~81k.. Date .................. Al~g~;. · '3'" 19'66 THIS C]~RTIFIES that the building located at ~/~...~]S:il~l.-~8.~ .... '. ....... Street Map No..~ ......... Block No .... ~ ...... Lot No. ~ ..... Sox~;h~..~.~., ....... conforms substantially ~o the Applicati~on for Building Permit heretof, ore filed in this office dated ............ ~Ol*i~...~.., 19.6~ pursuant to which Building Permit No. 30~..Z'- dated ............... ~]p~.i~....~ 19~., was issued, and conforms to all of the require~ ments .of the .applicable provisions of the law. The .o.ccupancy f. or which this certificate is issued is .~.~O-.~. 0D.0. ~,~y..(1~9.~.'1 ~g .......................................... The certificate is issued t~ . iIObOi'~;. &. ])~1t11~. · .]~l~t~' lessee or~e~nant) ' /owner, of the aforesaid building. ,Suffolk County Departmenf of Health Approval Building Inspector FOR, M NO. ~ TOWN OF $OUTHOLD BUILDING D~PARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) . N? 3041 z Date ............................. ~VriZ.....~. .......... , ~9..6.~. Permission is hereby granted to: R~b~.~..~_~..Dlaa~.....~.'~;~e.~ ............................ .................... ..5e~.~ ........................................ to ....... ~B~L ld.. ne:~..c~u~...Z~i.l~...d~e ~.li~ ............................................................................... at premises Iocoted at ..... ]~J.8.....~airl..~.~o~c] ....................................................................................... ............................................... So~tho]~ ~.....~. ~:.. ............................................................................... pursuant to application dated ............................. ~prJL~ ....... .~ ..........19...(~, and approved by ~the Building inspector Fee $...lC4,.00. ........ Building ~Jnspect~ 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 (Give deed loca~tion)' have been inspected by this department and found to be satisfactory. District District Engineer FORM NO. 1 ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved ........................... }! ........... , 19.¥..:... Permit No ............................. (Building Inspector) Application No, .25D0 L~, ( APPLICATION FOR BUILDING PERMIT Date ......................... ...~...~ ........ INSTRUCTIONS a. 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 property must 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 part for any purpose whatever until a Certificate of Occupancy shal~ hove been granted by the Building ~nspector. 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. ....... ..D.. ................................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Name of owner of premises .~/?.~).~.~..~'.....,d. ......,~./.2~'./.~....Z/~./.2-~/~..~....,Z~-.....~z~'-~4~A4'. *~.~ .~..~. ...................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed wo, rk will be done. Mop No.: ........................................ Lot No.: ........................ Street and Number...~../~./..4~'.....~,',~..~zC.! ...... .~.~.-~.~.,(~'./.. ......................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...r~.../...~.dg(..~ ............................................................................................................. b. Intended use and occupancy ..~.Z..~'.X-~.;.~.~ ....... 3. Not~re of work (check which applicable): New Buildin~ Addition Alteration RepAir .................. Removal .................. Demolition .................. Other Work (Describe) ........................... j ............. 4. Esti~pated Cost .../././..~.'.(2c2., ............. i ..................... Fee .......................................................................................... (to be paid on filing this application) 5. If d~velling, number of dwelling units ..... /. .................... Number of dwelling units on each floor ./. .......... ~ ............. If g~rage, number of oars ............................................................................... ..........~ ...................................... , ............. 6. If b?siness| commercial or mixed occupancy, specify nature and extent of each type of use .............. i ........ ~ .... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Hei ht ........................ Number of Stories ................................................................................................... ~ ............. Dim ;nsions of same structure with alterations or additions: Front .................................... Rear ............................ Dep h ................................ Height ............................ Number of .Stories ................................ 8. Dim ~:nsions of entire new construction: Front ....-~.7~Q'~'. ........................ Rear .....~'~.-~.. .............. Depth .s~...~..j .............. Hei.~ ht . ./Z~..../~...... Number of Stories .... ./.. ............................................................................................... .............. 9. Size of lot:_Z~Front .....~..~.~g~,~./:/.. Rear .................................... Depth ................................ 10. DatA of Purchase ....~./~q..~..~../..~....~.. ........................ ;...~am~e of Former Owner 11. Zen? or use ~istrict in which premises are situated ~....(¢~d~......~.~..C~.....c~-~.~,~.ff ............. 12. Doei proposed construction violate any zoning law, ordinance or regulation? ..x~..O. ................................... ~ .: .............. 13. Nar~e of Owner of premises6~e'4~..Z,...~e.,~,g~Z~ddress .~.,~./R.~b'...,~.~x&g.~..~'~'/-~,/~/Phone No ..................... Narpe/ of Architect /.~aq.~...~./~..~.~:.~.c'~.....cT.~ ......... Address ............................................ Phone No ..................... Nam. I e of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM kooat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names andl indicate whether interior or corner lot. STATE OFJ NEW YORK, 1. e e COUNTY [OF ................................ l(Name of individual_s'_~ nir~g application) above nar~ed. He is 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 file this applic:tion; that all statements contained in this application are true to the best of his knowledge and belief; and that the w,,rk will be performed in the manner set forth in the application filed therewith. Sworn to ,fore me this ~ ~ .................. day of ................................... , ........ . ...... ................. Nota,y Pul fiic, ~..~.].~...~,...~~. County (Si~ature o~applioant) . / ~/ MARION A REGDI~ -- : ~ ~OTARY PU~LII;, Stato ~o, 52-~33120 ~rm Expires ~arch