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HomeMy WebLinkAbout3075-zFORM ~0. 4~ TOWN OF SOUTHOLD SUILDING DEPAI~TMENT TOWN CI~ERK'S OFFICE SOUTHOLD. 1~. Y. OERTIFil]AT£ OF O00UF~ANOY THIS CERTIFIES that the building located at . ./.~..~qi~'.l~¢,~..pp~4. Ua ....... Street Map No. Fairview ~orc~ No. . Lot ~o. ~ 3 . SOUt~Ol~,.. I~,~. conforms substantially to the Applicati, on for Building Permit hereto~.ove filed in this office dated ........... l~y .... 6 ...... 19.64 pu.rsu/tnt to which Building Permit No..3f)~~. 'Z dated ........... M~.y.. ~ ....... [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 .Privage. One. F.a~o. lly..D~,,~el~i:lz~,g. .......................................... The certificate is issued to . D~d{g~a.~ .I)OX~]~' ............ ~'1~ · ~ · ~ ~ ~ ............... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval ~,f:~:'~.~ ~:.......: .... ~ ............ ~,. ...... Building Inspector ~ FOPoM NO. 2 TOWN OF SOUTHOLD BU~LDIh{G 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? 3075 z Permission is hereby granted to: ..~::~o.?.~:'~m...~.?.~.~.~ ............................................ ....... 6.:.L.6.... %~ ~.~..,?~ ............................................ ............ ~ ~.~D.Q;¢.~ ~,...~'., X,, ................................ to . ~.~.~L ] ~... ~,. ~z~ ~... £ ~ ~.3.~r.,.d~ :_~ &$~ ..................................................................................... ct premises located at .....]E.*.O..~.....~a.....~.~'.~.J..~;%~..P.~J~. .................................................................. .......................................... .~:,~/,.~ ...,,!~i~,~ ..p.o~.~,L. Lan,e. ~ ......... .$ o.u~;.ho.~.d ..................................... pursuant to application dated ..................... YJ~. .............. ~. ................ 1c)~,~...., and approved by the Building Inspector Fee $~t, 0,,.0.0. ............ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for ~ structure located (Give 8~ed location) .... have been inspected by this department and found to be satisfactory. District Enginee~ District Engineer FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ^ppraved ........................... :.*. .......... , Pe,m,t No. Application No....~..~.Z ~'~-. ........ Disapproved a/c ........... ~ ...................................................................... ...................... ..................... (Building I~spec~r) APPLICATION FOR BUILDING PERMIT Date ............................. ; ............................ , 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 premi.ses 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 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 alteratio/9~, or for removal or demolition as herein described. The applicant agrees to comply with all applicable laws, ordinan~Ts,~ buildir~ code and~,-C~ulations. .... ....... ........................ (Signature of applicant, or name if a corporatioh~) (Address of applicant) % State whether apRlico?t is owns,r, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................. x...~ .................... ' ........................................................................................................ 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.: ........................ Street and Number ...................................................................· .................. ~.,.,,, ........... ~.f..6¢~.,.t,'..~.¢ ...... -¢.~;¢,A,;',,¢,%,~. Municipali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ......... ,¢ ...................................................................................................................... b, Intended use and occupancy ' 9. 10. 11. Zone 12, Does 13. Nome Name mature of work (check wh ch app cab e) New Bu ding ~ Addition Alteration Re ar ~ ' .................... ~ ' · ................. .z~emoval .................. Demolition ......... Other Work (Describe) .:L. ,f,,a ed Cost ........... ........................................ Fee t (to be paid on filing this application) If welling, number of dwelling units ...... .r.?../~./.¥~.~..,...Number of dwelling units on each floor ....L... }f g rage, number of cars ............................. , If us'n ss, commercial or mixed occupancy, specify nature and extent of each !~ype of use ...... D mens/ons of ex st ng structures, f any Front , ,.L~,.~z.~..~ ..... Rear ........ .~;;7,T.'.~:.,',~ ......... Depth Height ........................ Number of Stories <~- Dimensions of same structure with a,Jterations or additions: Front ........ ;".;:Ti:~.~..~ ............. Rear ?~,..~'~..~'! Depth .................... -,; .......... Height ....... tr....:...;:;;..L...Number of Stories ..... Z,...........~--~T.;:7. DimJnsions. ~ __.al entire new construction: Front;~i"~,:~i~d.).~....'.~..?,~ ........... Rear ....~.'~!~'*.~. ~ De,-*t, (~ ~? t Heig~trr. r.~.'.c.~:,'(;...~.'.'.. Number of Stories ........ C~....~..~: ............. Size* ~f lot: Front ...Z .~.~..,,~... ............. Rear ...... /...~,...~ ................. Depth ...J..~..~i~-ii.~.. ........... Dote jot Purchase ........................................................ Name of Former Owner )r use district in which premises are situated .......................................................................................... ~ ........ ,roposed construction violate any zoning Daw, ordinance or regulation? ..... /~x/...~. ...... of Owner of premises .,.,,~...~..~..~../..~;...~...A.!.~ ...... Address ............................................ Phone No. of Architect ...................................................... Address ............................................ Phone No ........... ~ ........ Name jot Contractor .................................................... Address ............................................ Phone No. PLOT DIAGRAM early and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions, from Give street and block number or description according to deed, and show street names and indicate ,r or corner lot. Locate c property line~ whether interi © 0 STATE OF NEW YORK, S S COUNTY OF .............................. ,f ' ' ................................................................................................ being duly sworn, deposes and soys that he is the applicant (Name)findividual~ .,~,z~'~..~ /~ ~__~ ,~ _,~..-~-~ ~_~signingapplic~i°n) ,. above named, He is the ...... ~....,..~...~'."..~.:":..'~./....., ,(~¢:,,,C~..../~..,.~.~..'",;.~..~,.(.~.'~:;..!.".c.:~.~.~ ................. (Contractor, agent, corporate officer, etc.) of said owner or ~ners, and is duly authorized to perform or have performed the said work and to make end fil~ this application; ti at all statements contained in this application are true to the best of his knowledge and belief; that the work will I performed in the manner set forth in the application filed therewi}h. Sworn to before m~ th s ,- , ........ of ...... ................. , , Notary Public,/d,/~...~.:...[~~... County '~)~%"~ <Sianature of a,olicantl ' ~o. 52-3~3120 Su((o[k C~?ty~ )erm ExpJms M~rch 30, ~9~