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Home My WebLink About3152-zFORM 1~O. 4 TOWN OF ~OUTHOLD BUILDING I)EFABT~IENT TOWN CLEEK'S OFFICE SOUTHOLD, N. Y. GEF~TIFIE:ATE OF' OCE:UPANi~Y No. Z '~1 .... Date ................. THIS CERTIFIES that ~he building located at . .~V~.~ ............. Street ~ap No ............. Block No ............. Lot No. ~ ......... ~'~Ok ............. conforms substantially ~o ~he ~pplica/i,on for Buildin~ Permit heretof.ore fried in this office dated ............. ~'~ ..... ~.~ 19. ~ pursuant to which Building Permit No..~. dated .......... ~ .... ~ .... 1~.~6., was issued, and conforms to all of the require- ments ,of the .applicable provisions of the law. The ,occupancy for which this certificate issued is .. ~l~to' 'on, 'f~il~' d~elI~ ......................................... The certificate is issued ~o . .~aGBO~ .l~e. , .... ~ ................................ (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ......... A?Z'~" ~' ~" Building Inspector TOWN OF SOUTHOLD BUILDING 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°, 3152 z Permission is hereby granted to: · .~: a~,e~...~e-.~ ......................... ; ............... ~ ....... ' at premises located at ...... ~.'t5..~,~.~.-...~[t.~..~¢,$~--~,'~- ............. : .......................... , .............. ............................ ,~/,:~.,...~,',~:~c~; ~x.~ ~ ~,· · ,~a~ ~.- ......... ~4~:~ea~'~'' '~'~ ~ ....................................... pursuant to application dated ............................... J~,~r.....:~.~ ........... 19..(~., and approved by the Building Inspector Fee $'"~O' ,'~0 ......... .......... ~...~.~, .~:, ....................... ; ....................... ..¥ .... Building Inspector ~ s-9 SUFFOLK COUNTY DEPARTMENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disoosal facilities for a structure located at (~i~' deed location) .... have been inspected by this Department and found to be satisfactory. Distriot En~inee~ .~' , District Engineer FOE1V/ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......(~ {~)' · .,,.~...-T~...~.~.~...../~..'.'~......., Approved ........................................ , 19.~ ..... Permit No..~.../ ~'~'~"~'" Application No. ~'~/ 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 drown 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 aDerotions, or for removal or demolition as herein described. The applicant agrees to comp y with al app icab e aws, ordnances, bu Iding code and ragu orions. (Signature of applicant, or name, if a corporation) ......... (Address of applicant) ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. I~ is~afcorporate, signgt~tce of d,u~ authorized officer. ....... ~J~ame and titlu~of cor{RpFrote officer) 1. Location of land on which proposed work will be done..Map No.: ..: ...................................Lot No.: ................. treet and Number ........ ................................. ........................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a, Existing use and occupancy ................................................................................................................................... occupancy .......... '.~.....,~~. ...... .~ ..................................................... b. Intended use and 3. Natur of work (check which applicable): New Building ...~ ....... Addition .................. Alteration ................. Repai~ .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimcted Cost ........i).~..:r~..:...~ ...................Fee ......................................................................................... (to be paid on filing this application) 5. if dw,lling, number of dweIli~ni~ ........ ~ .......... Number of dwelling units on each, floor ........-:~... ............... If gm ge, number of cars .... ~..w ........................................................... ' ....................................................... 6. If business, commercial or mixed occupancy, specify nature and extent, ~f each type of use .......................... 7. Dime ~sions of existing structures, Jf any: Front ......~ .................. Rear ............. ~ .................. Depth ......... ~ .......... Heigt t ........................ Number of Stories , Dime~sions of same structure with alterations or additions: Front .................................... Rear ~ ~ Height Nu be of Stories Depfl .............................................. ~ ....... m r 8. Dime ~sions of entire new construction: Front ..... ~..~.~. ................... Rear ........ ~..~ ............. Depth ....~.~. ......... Heigfft ...~.~.~ ...... Number of Stories .......... /...~ .................................................................................................. 9..~,ze of lot: ~ront ......./~ ............. Rear ........... ~ ..................... Dap h .............. ~,~.~ ..... 10. Data'of Purchase ....... ~ ....... ~.~.~.~.C ............... Name of Former Owner .~.~..~...~... 1 1. Zonelor use district in which premises are situated .................................................................................................. 12. DoesIproposed construction violate any zoning law, ordinance or regulation? .......... ~ ...................................... 13. Nam~ of Owner of premises ~...~..: ....... Address ....... ~~.,.. Phone No.~.~ Nam~ of Architect__s. Address .........................................,~ ~ ~ Phone No ................... PLOT DIAGRAM Locate :leariy and distinctly aH buildings, whether existing or proposed, and indicate ail set-back dimensions fror property ~in ~s. Give street and block number or description according to deed, and show street names and whether inte'Jor or corner lot. STATE OF~EW YORK, ] ¢ c .............. ..~.1.~ ....... ~ .............................. being duly sworn, d~oses and says that He is the (N~me of individual signing qppNication) ........... ............................................................................ ~ (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 application; that all statements contained in this application are true to the best of his knowledge and belief; that the w~k will be performed in the manner set forth in the application filed therewith. Sworn to b~fore me this N~RY-~gBL~C, Stero o~ qo'.'~ yolk RO ~,O