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Home My WebLink About3101-zFORM ~O. 4 ~OWN OF SOUTHOLD ~UILDING DEPARTMENT TOW~ C~ERK'S OFFICE SOUTHOLD, N. Y. P..EI~TIFIE:ATE: ElF 13P-E:LilnANP. Y No..Z. ~38... Date ................. 0etobe.~.. ~'3, 1966' THIS CERTIFIES that the building located at ~l~'dWO'Od' ~ ']~1~I~' MOU(I' Road Street Map ~.~.t;..~..0.0.~..~.~.~t~k No ............. Lot No .... 8b'' '(~llt~(lhOgllo~' i~i¥', ........ conforms substantially to the Application for Building Permit heretof, ore filed in this office dated ......... Ma~'" ~(~ ...... 19.66. pursuant to which Building Permit No. ~.0~l/.7/ dated .............. i~t&~r..~ .... 19~., 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 .. 'P~.V~.'~' iSfl~' 'f&hi:[~.~ 'd~d~l~'iff~ ........................................ The certificate is issued t,o 'K~I'~[' 'Fll'Igttl'O' &' 'l~i[I~O'('~i~'~ .................. tenant) of the aforesaid building. Suffolk County Department of Health Approval ..0~.~.,,~¥ ~uilding inspector 1 FOP~M NO. 2 TOWtq OF SGUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S O~FIC[ SOUTHOLD, N. Y. BUILDIHG Pt:RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL'FULL COMPLETION OF THE WORK AUTHORIZED) No. 3101 z Permission is hereby granted to: pursuant to application dated .............................. [~.f~. ......... ~.~. ......... 19.~.., and approved by the Building Inspector Fee $....1.O~,QO. ....... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure (Give deed location) located have been inspected by this department and found to be satisfactory. D~t~ie~ En~inee~ District Engineer FOEi~ NO, 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................................... ~........~.., '"' 19....~.... Permit No. ~.~....~....~.. / Z , Approved ........................................ ~ ................. Disapproved a/c .............................................................................................. .............................. ................................ Application No....-~...~....O...L .......... 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 property must be drawn on the diagram which is part of ~his 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 wilt issue a Building Permit to the applicant. Such peFmit 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordina~?~uilding co, de and regulations~ .. (Sig~tu re of app "" ~r"~'~'~?~, ,me~orporati f ' ' ' ' ' ;';1~';';~¥ i o ;')' ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Nome of owner of premises ...~.'~t ...... .~..~,..~.......7 ..~.,w~ ' .':ff~, ~. ........................................................................ If aDt~licant i~ o ggrporate, signature of duJy~auth(~rized officer. ............. . .............. (Name and title of corporate officer) 1, Location of land on which proposed work will be dane. Map No.: ..... .¢~...~...,.,~.'.~..~.....,-- ---- ........ Lot No.: ..... ~ ............... Street and Number ..~..~,~.....~../_z..~ ~.. .... ~.~.,~'.~.~r~..~.~.. ............................ Municipality 2_. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use end occupancy ................................................................................................................................... b. Intended use and occupancy .................................................................... : ............................... 3. Notbre of work (check which applicable): New Building Y Addition Alteration Rep,~ir .................. Removal .................. Demolition .................. Other Work (Describe) ................................... ...... L..°.. ......................................................................... 4. Esfidnoted Cost ........ ~...~,~...~...~, ................................... Fee (to be paid on filing this application) 5. If d~velling, number of dwelling units ......... /.. ................ Number of dwelling units on each floor ........... ~ .......... If g?age, number of cars ............~ ............................................................................. ~ .......................................... 6. If t~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 7. Dim'ensions of existing structures, if any: Front ............................ Rear ................................ Depth ................... Height ........................ Number of Stories ............................................................................................................. Dimensions of some structure with alterations or additions: Front ....................................Rear ........................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dim',ensions of entire new construction: Front ...... ~,..~, ..................... Rear ...... ,~,,,~, ............. Depth .,....~....~. ....... Height ......./,.~. ......... Number of Stories ..~ ................................................................. 9. Sizeiof lot: Front .....~...~,.~../. .......... Rear ......... ~,/...~.~..o... ............. Depth ..... /'"'~""/"",~'~'i~ 10. Dat~ of Purchase J..~...~,..~..i~. ...................................... Name of Far,met Owner ..... g..:.~.....~r,~4~.<.~ ................ 11. Zone or use district in which premises are situated .......... /..-tS, ........ ~ ............................................................ 12. Doe~proposed construction violate any zoc~ing law, ordinance or regulation? ....... .~.J../....~. ...................................... 13. Nar~eof Owner of premises ..~f~.Z...~...~ ............~ddress~,~~ ............ Phone No/..~..,~.. ~. ~' Na~e of Architect ..................................................... .Address ............................................ Phone No ................. Nam, e PLOT DIAGRAM Locat~j clearly and distinctly oil buildings~ whether existing or proposed, and indicate all set-back dimensions fr property I!~es. Give street and block number or description according to deed, and show street names and ,india whether intrrior or corner lot. STATE OFNEW~I~RK,n/) COUNT, (Name of individual obove nomad. He is the ...... duly sworn, deposes and soys that he is the applic( (Contractor, agent, corporate officer, etc.) of said own~er or owners and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and belief; ar that the woPik will be performed in the manner set forth in the application filed therewith. Sworn to b,,efore me this ....... day .................... - . Nota~ Publ. ic, .~~~~,... ~nt~ (Signature of applicant) No. 52-0618100.. Su~fd~ Cou~,t~ C~mmiss on