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Home My WebLink About3068-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE ElF OP.P. UPANP. Y No. ~..2..~.. ~ ..... Date ............. .~. 1~;... ~ .... , 19. (;7. THIS CERTIFIES that the building located at .W~ .l~/e,~],8. t1~).~1~ ........... Street Map No...xX ...... Block No... ~ ....... Lot No. ~ ..... ~;~l~Q],d~..l~,~{~ ....... con£orms substantially to the Application for Building Permit heretofore filed in this office dated ......... A. py.~.. 2.~.. , 19~ . pursuant to which Building Permit No. 30.~8. ~. dated ......... J~l'l],l ....26. ·., 19.6~, 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 ~l'.l.~/~.~. ~/t.e.. ~'al~l~,Y. d.,4~llJJgg ....................................... The certificate is issued to . ',/~.llia~ .[}l'i/lollis ........ 0w~e~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval..S.c..p~..1..~.~..1.9..67...b..y..~.,..y..~:1..~.. FOI~M 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) N? 3068 Z Permission is hereby granted to: Wm....}~,... ~m&th ..~dC.....~'~.~, :L.]~i~...G~& ~n~.$ ... ............. .~t~Ld ............................................... to. · · .]]~, 1~1, · · tc~e~ · · ~e. · .~. ~.%1.~7. · ~1~ ~..],~.~-~ ................................................................................... at premises located at ...~.~..~]~.],~...~ ........................................................................................... .................................................. -~ ~u~1~)~1 ~ ......~k. ¥ ~. ............................................................................ pursuant to application da~ed ................................ ~.]D:Z'.~L.~.....~. .... 19.~6.., and approved by the Building Inspector Fee $.3.t~0.0 .......... TO WHOM IT MAY CONCERN: SUFFOLK COUNTY DEPARTMENT OF HEALTH Date_~/~ ~ The sewage disposal facilities for a ~tructure located at (~-i~e deed location) have been inspected by this Department and found to be satisfactory. District Engineer "' Distric~ 'Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved ........................................ , It) ........ Permit No .............................. Disapproved a/c ........~ .............................. (Building Inspector) 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 propertyrnust 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 i~sue o Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No buiiding shai1 be occupied or used in whole or in part for any purpose whatever until a Certificate of,Occupancy shall have been granted by the Building Inspector. APPLICATION tS HEREBY MADE to the Building Departrnent 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, ordinc~ces,/f/I building code and regulations.//x._7~<x' ,. ~/~ ........................ : .............. z: .............. ..5~.....~..:.....: ........... :: ........ (Signature of applicant, or na~e, if a corpqra¢ion)~ .... ........ ..... ................... ...... (Address of applicant) / State w~ther appli~L!~, I~_s_s~?.~.~.agent, architect, engineer, general contractor, electrician, plumber or builder. ...... ~ ............................... ~7"T'V ~ '~""": ................... 7/ ........ : ............. i .................................................................. Nome of owner of pram ises .../~',,~ ~,,..~.~.~./.z..d'..~.~. '.~.~. ~~?~ ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ..~ ...................................... Lot No: .i~ ..... St ree~ and Nu m bar ...... ~'. ~.~.~,c~..,~ .~..~.. ~.'.~.../~........ :~:~,.~.~..~ .?, .~..... ............................. i ........ umc,pa ~ y -2. Stote existing use ond occuponcy of premi~ses ond intended use ond occuponcy of proposed construction'. 10. 13. property Ii whether in Nathre of work (check which applicable): New Building Addition .................. Alteration Rep,~ir ....................Removal .................... Demolition .................... Other Work (Describe) ........................ i ........ Estimated Cost ..................... ~x..~)....~.......~? ............... Fee ............~?....~.....-.~-.. ........................................................... j -- (to be paid on filing this application) If d~elling,j number of dwelling units ........ ~.../.. .............. Number of dwelling units on each floor .............. ~ ........ If gl=rage, number of cars ............................................................................................................................. ~ ........ If b.'usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................... DimJensions of existing structures, if any: Front .......................... Rear ..........................Depth .............. i ......... Height Number of Stories Dim!ensions of same structure with alterations or aad'tions: Front ................................ Rear .................. ~ ......... Dep th ..............................Height ............................... Number of Stories ........................................ Dirt ensions of entire new construction: Front ............................ Rear ............................ Depth ......... ~,....~ ........ Hei~lht ....... ~...~. .............. Number of Stories ......... ./. ................. SiT( of lot: Front ..../...~../. ............... Rear ............................ Depth ............. ..~.. .......... /... a ~ ' , Dot~ of Purchase .(~.,....~..~.. .................................. Name of Former Owner ....~ .~...~ Zone or use distric~inVwhich premises are situoted....~ ..................................... Doe; proposed construction viola, re ~ny zoning law, ordinance_ ,.- __°r regulation? ..... ~..~ .......................... i ......... Nar ~e of Owner of premises ..~.:..~.:.~ ....... Address~~.~......~ ...... Phone No....~Z./~...~...~ Nar ~e of Architect .............................. L' ...................... Address ............................................ Phone No ....... ; ......... Nar~e ol~ Contractor ....~......&:....~..~'~, ............. Address .~-.....~ ............. Phone No. PLOT DIAGRAM ~ clearly and distinctly all buildings whether existing or proposed, and indicate all set-back dimensibns fr ~es. Give street and block numbers or description according to deed, and show street names andl indic erior or corner lot. STATE OF NEW YORK, COUNTY OF ................................ ) S.S. ................. I ................................................................................ being duly sworn, deposes and says that he is the 9pplic (~ame of individual signing application) above n.arled. He is the .................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said ov~er or owners, and is duly authorized to perform or have performed the said work and to makela?e this appli(ation; that all statements contained in this application are true to the best of his knowledgeand and that t ,ef~re me this , ,~ J , ~,~ /} , ,,~ // / ,/ ~.~..-~:q.'~"~.ihe work will be performed in the manner set forth in the application filed therewith. -- , .~...... day of ....~ .......... : ...... , 19..~...........~...~.~.?, ~ Noto,-y ..... ....... ' '" ~JOTA~I ' "', '" ' ' ' ..... : ............................ 'fe[m Expirss M~ct~ 30,