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Home My WebLink About3070-zFOEM IVO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. No. Z. 'e~O9 .... Date ............ THIS CERTIFIES that the building located at ...~/.t~..~.q.e.k.e.y..0.1?.e.e.l~..D.I?... Street Map No...~X ...... Block No.. ~ ........ Lot No.. conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated ............ l~la~... 2..., 1966. pursu'ant to which Building Permit No. 30~0-Z.. dated ............ }lay .... 2..., l!~(~.., was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .occupancy f. or which this certificate is issued is .. P;~l.vate..ona. faani~Llt, ct~elling ......................................... The certificate is issued to . ~tll~l'Cl .&. (ih~$'~..~letltaIllt ....... DI411eI~ ..... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . ~l~telllb~l~...2.3~..1.~6~...b~ FOP~M NO. 2 TOWN OF $OUTHOLD BUILDIHG DEPARTMEHT 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? 3070 z ......................... , 19.....:.. Permission is hereby granted to: pursuant to application dated ...................... .~..'~./ ....... X ............... 19.~:.~.., and approved by the Building Inspector Fee $..../.¢~ ................ SUFFOLK COUFI~ DEPAEr~ENT OF HEALTH TO WHOM IT MAY CONCEIt: Permit NO,,__~ The sewage disposal facilities for a structure located at (Give deed location) have been inspected by this Department and found to be satisfactory. ........ 'strc" ng nee~ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................... .¢.~'~, .............. , ........ Approved ........................................ , 19...~... Permit No. ~ ~5 '? C~ Z~ Disapproved a/c .......... ~ .......... - ...... , ................................ · ................................ Application No ............................. APPLICATION FOR BUILDING PERMIT Date ...i~........~..~ ............... , 19.~.~ ..... 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. Su~;h permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building sh~ll 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 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. (Signature of applicant, or name, if a corporc~tion) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~m.~.Z~.Cg~D....../~ ....... ...~......c~.lg,.t.':k.~,.C~.LT...-E... -~ ....... i~ ...... ~.~.~.~.~.~1..~ ........... if appJicant is a corporate, s~gnature of du~y authorized officer. (Name and title of corporate officer) I. kocotion of Iond on which proposed work will be done. M~p ~o.: ........................................kot Mo.: ~.~...[.~. Strem ond ~umber ............... 2~.~.~......~.~_~.~.~.....}..~.~M~....~_.~.~..~.[~.~.D-:~..~.'.[~ ................. ~unicipallty 2. State existi~ use ond occuponcy o{ premises ~nd intended uso and occupancy o{ proposed construction: o, ~xistin9 uso ond occuponcy ................................... : ............................................................................................... b. Intended use ond occuponcy ............... ~.~-~.[.~...~ ............................................................................... 3. NatUre of work (check which applicabJe): New Building ....... Addition .................. Alteration .............. Rep6ir .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Estmhated Cost ................ .~-~n..g.O.g. ...................... Fee ...................................................................................... Ii (to be paid on filing this application) 5. If d~elling, number of dwelling units ......... ~ .................. Number of dwelling units on each floor .......... /. If g?rage,/ number of cars .................... ~ ................................................................................................................ 6. If b'usiness, commercial or mixed occupancy, specify nature and extent of each type of use ............... ......... 7. Dim?,sions of existing structures, if any: Front ............................ Rear ................................ Depth ................... Height ........................ Number of Stories .................................................................................................... , ......... D~m~ns~ons of same structure with alterations or additions: Front ....................................Rear ........................ Dep}h ................................ Height ............................ Number of Stories ................................ i 8. Dimensions of entire new construction: Front ........... g..~ .................. Rear ......... ~.~ ............ Depth .....Q.~ ......... Hei~ht'l' ...... j..~ ......... Number of Stories .................. t ............................................................................................. 9. Sizejof~ lot Front ........ i..~.~ .......... Rear .......... I.~.Q ................ Depth ....... ~.~.~ .............. 10. Dat~ of Purchase ........................................................ Name of Former Owner .................. ~ ................................. 1 1. Zonb or use district in which premises are situated .......... ~.~.S .................................................................... ~ ......... 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ......... ~.~ .............................. ; ......... 13. Nonce of Owner of premises~,..~.~m~mm.~ddress ~.q.,Z.tf.~.~.~....~.:.~ ...... Phone N Nonce of Architect ...................................................... Address ............................................ Phone No. Nan,e of Contractor .................................................... Address ............................................ Phone No. PLOT DIAGRAM L.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property Ii ~es. Give street and block number or description according to deed, and show street names and indic whether int,rlor or corner lot. STATE OFJ N EW~, ~/ l S S ...~~~:~~~..f ............ being duly sworn, d~oses and soys that he is the applic, above no,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 this applid, ation; that oll statements contained in this application are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. Sworn to b~re me this