The URL can be used to link to this page

Home My WebLink About3097-z~'OWN OF ~OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. I]Ef~TIFll]AT£ OF OI]I]I_II:ANr. Y No. ~J. ~.~l~ ..... Date ............. 0Ci;OtoellY · · ']'8 .... , 1966' THIS CERTIFIES that the building located at .13./.~.. ?.'J-bo. DF .............. Street Map No. ~ ........ Block No..XX~. ....... Lot No. :lGe~ .... l~atllt'e~.~. I~.~Y, ............ conforms substantially to the Application for Building Permit heretof, o.re £ile.d in this office dated .......... ~a~ ..... 20., 1966. pursu'ant to which Building Permit No. '3097. .~'. dated .......... Ffay .... gO .... , 1966., was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .occupancy ~or which this certificate is issued.tis . .Bl'l.vate -one..f. am.i.l.y, dwe.q, t ing .......................................... The certificate is issued t.o .. t~ob~Pt, lq,..T~i~laet~ ........... Ot~ol,~ ................. : (owner, lessee or tenant) of thb aforesaid building. .Suffolk County Department of Health Approval . ./k~g~. '~9)' '~1-966'' .13y. 'R~..Vl'~.J:'a ..... Building Inspector FOI~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERRTS OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE 'KEPT ON THE PREMISES U~qTiL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 3097 Z Date Permission is hereby granted to: .....~.[~.,:~.....:....;...,.~..~.:..::.t:. ~..:,:.~:~ ............ ~o ....~Ll~...~.~m.cm~..~l~ :~,~31n~., .. .............. [ ......... .. at premises located at ....~/,.~.,...~..~.~ .~ .................................................................. .................. ~u~.e'.Z..~......~:.~... ............................................. · . pursuant to application dated ............................. ~3.~.....~0. ................ 19~..,., and approved by the Building Inspector S-9 SC~D SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM at IT MAY CONCERN: The sewage disposal facilities for a structure (Give deed location) located have been inspected by this department and found to be satisfactory. District Engineer District Engineer FO~M ~0.1 TOWN OF SOUTHOI. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ......Permit No .... APPLICATION FOR BUILDING PERMIT 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 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 ~he 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 a~terations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordlnance/s~ilding code and regulations. ..... ....... (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 promises ................................................................................................................................ If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................,Lot No.: ........................ Street and r~umoer ................................................................................................................................................... Municipality 2.State existing use and occupancy of premised use and occupancy of proposed construction: a. Existingu~e and occu~ ~nls ~a cy ................r-/ / ' ,'/.// ,'~ __~~~"~f"-;"~-') ......... ....~/. .............................................................................. b. Intended use and occupancy ....~.~~...~/~...~..~'~ ............................................................... 3. Not~re of work (check which applicable): New Building .................. Addition .................. Alteration ............... Repa:ir .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... " ....... 4. Estlr~oted Cast ~..~...~¢~.. ............................. Fee ....................................................................................... I , (to be paid on filing this application) 5. tf d~elling, number of dwelling units ....~: ........... Number of dwelling unils on eac~ iloo...r ........................ If glrage, number of cars .......................................................................................................................... : ........ 6. If b'usiness, commercial or mixed occupancy, s~ecify nature and extent of each type of use 7. Dimj~nsions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ............................................................................................................ DimFnsionsl of same structure with alterations ar additions: Front ....................................Rear .............. Depfhh ................................ Height ............................ Nymber of Stories ............. , .................. 8. Dimensions of entire new construction: Front ......... .......... Rear ....~..¢/...-~ ....... Depth Height .................... Number of Stories 9. Sizelof lot: Front .......~..~. ................ Rear .......... ./..~.. ..................... Depth ...... ./...~...~....; .............. ,o · 10. Dot~ of Purchase ..~(~.,...~/.~.~...J .............................. Name of Former Owner 11. Zen, ~ or use district in which premises are situated ...... ..~...~...~...~..~..Z..x ...... ~.. t.~... 12. Doe,~ proposed construction violate any zoning law, ordinance or ulation? 13. Nan,e of Owner of premise ~(.......~.~....~.,ZZ.~.~.....Address Phone Nonce of Architect ...................................................... Address ............................................ Phone No ................ Nan of Contractor L:...,?.~I..'~..~...O..././~...~....~...~..~',~'"./?~--Address..~.~..J,"Z,4~7~'7..,~.,./~:.. Phone PLOT DIAGRAM L.ocat$ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f~ property lihes Give street and block number or description according to deed, and show street names and indic, whether in ~rior or corner lot. STATE OFJ NEW.OR, K,") ~/] ~ c c COUNTYJD%'"4~ ~.~.,~...~ ''''''~ ................. iName of indivi~i~'~'l si~;[~g application) duly deposes and soys that he is the apptic{ above non'ed. He is the ..............~,t~C).~.. ................................................................................................... ~ ......... i (Contractor, agent, corporate officer, etc,): of said o~ this applic that the w, Sworn to Notary Pu ~er or owners, and is duly authorized to perform or have performed the said work and to make'and :tion; that all statements contained in this application are true to the best of his knowledge and belief; ~rk will be performed in the manner set forth in the filed therewith. ~fore me this ~. ..... day of )lic, ,., 19...~..... NO ~.0618100 Sm,u, commmsion Expires ~ c~ (Signature of applicant) I