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Home My WebLink About3082-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE DF BBBUPANBY No.& 286f~ ' . Date .......... 0e.~ol~e;~ .... ]Lg.., 19. THIS CERTIFIES that the building located at l~/8., lilollth .DI'i~e ......... Street Map No. . ~ .. Block No.. ~ ........ Lot No. ~fl~. · . ~,a~;..F'~al~lort~. N,~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... May .... 10.. , 19 66. pursuant to which Building Permit No..308g dated ........ l~y. ....lQ. , 19.66, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .Pri~at;e .one. fami~..dwmlllng ....................................... The certificate is issued to .Chal~los. ¢%..0'otlr~so[t .................... ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .0et; .17, .196.~..~tll~.eeg..lo .:~tlaspeotiorl of drop 2 in cesspool % Building Inspector FOI~M NO. ~ TOWN OF 5ODTHOLD BUgLD]NG 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? 3082 z Date ............................. ~- .......10, ........... , 19.(~.. Permission is hereby granted to: .............. ~9~....~ em .~oz~ ¢,..f~.~ ........................ ................... ~o~e~a.~.....,~..,..~.,, ................... to ....~:LI~...~q..~)~. · ~..~.i. ~,~ · · d.~eZ.~.:L.~g ................................................................................... of premises located at ....~/~.....~O~.~....~......'?..~/~..~;~...]~,~....~,.~.'l~ .................................. .............................................. ~!,~, ~.~ ..~.~& e.~ ~ ...~.~ .E-~ .................. ..................................... , .................... pursuant to application doted .............................. ~.~.~, ....... ~0. ........... 19,,~4 and approved by the Building Inspector Building Ifispector pd&~ I& JACK ALUSO~ HALL LICENSED LAND SURYEYOR 999 SUNRISE HIGHWAY BABYLON, L. I., N. Y. N. Y. STATE LICENSE No. 30~?~ MOHAWK FOEM NO. 1, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. Approved ........................................ , 19 ........ Permit No ............................. (Building Inspecto~/V APPLICATION FOR BUILDING PERMIT Dote ...................................... ~.. ................. , 19 .. INSTRUCTiONS o. 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 areos, and giving a detai~ed description of layout of property must be drown on the diagram which is part of this applicotion. c. The work covered by this application may not be commenced before issuonce 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuont to the Building Zone Ordinonce of the Town of Southold, Suffolk County, New York, and other opplicable Laws, Ordinances or Regulations, for the construction of buildings, odditions or alterations, or fo~ removol or demolition, as herein described. The applicont agrees to comply with all applicable laws, ordinonces, bui~di~g code an~ regulg~ions. ....... (Signature of appli,czSnt, or name, if a corporotion) ..... ....... (Address of applicant) State whether applicont is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ........................................................................................................................ Name of owner of premises ....~T.,,~.,~Z'r~.~,.,q ....... /-,-Z~..,......~.~'.Z'.~.~.C).4~.. ......................................................................... 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. Map No.: ........................................Lot No.: ........................ Street and Number ..... ~.~......,~'~7.¢/Z~...~.......~.,,~.:......~(.~.~....~ ...... .~T'..r~.......~¢~......,~?..~.,~..~.,~'~.4,7....~/..~,. ........... / MunicipaJity ,.,.,.,.,.,.,.,.,.~. 2. State existing use ond occupancy of premises and intended use and occupancy of proposed construction: a. Existing use ond occupancy ................................................................................................................................... b. Intended use and occupancy ..../~,,...,.~ .~...~., ......../-......-~-.~.~.~· · . · · · · 4:5:~'.~. ~,~?.~-~- ..................................... NatUre of work (check which applicable): New Building ..~ ........ Addition .................. Alteration 3. RepAir .................. Removal .................. Demolition .................. Other Work (Describe) Esti.j.ated ........ __--~........... ................................. Fee (to be paid on filing this application) 4. 5. If d~elling, number of dwelling units ....... .~. .................. Number of dwelling units on each floor If ggrage, number of cars ....... /.. 6. If ~usiness, commercial or mixed occupancy', specify nature and extent of each type of use' 7. Dim msions of existing structures, if any: Front ...~)~Z~)~... ....... Rear ................................ Depth Hei ht ........................ Number of Stories Dirt :nsians of same structure with alterations or additions: Front .................................... Rear Dep h ................................ Height ............................ Number of Stories ................................ 8. Din~ensions of entire new construct.on: Front ...~..~. .......................... Rear ..~...¢~ .................... Depth .~.~...... ....... 10. Dat{9 of Purchase ..... .~/ff.Z[~..~,~. ........................... Nome of Former Owner ....~.~5.....<,~c..__ Zon~ or use district in whiz' ' 'ch pre'~ raises are situated ............. .. .................................... " . 1 Doe~ proposed construction violate any zoning law, ordinan~e~ or regulation? .....Z~..~ Phone Na~e of Contractor ...... Address · .... " Phone No. PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property li'nes. G~ve street and bfock number or description according to deed, and show street names and whether in{erior or corner lot. STATE OF : S.S. COUNTY above non being duly sworn, deposes and says that he is the applic Name of ed. He is (Contractor, agent, corporate officer, etc.) of said o~er or owners, and is duly authorized to perform or have performed the said work and to mokei and this application; that all statements contained in this application are true to the best of his knowledge and belief; that the w,~rk will be performed in the manner set forth in the application filed t~ewith. Sworn to b ,~fore me this Notary Public, .~~Zu~/~ / ~ (Signature/applicant) COrem:ss oa Expires March 30, 1~ " .. r I