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Home My WebLink About3163-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE DF DP.P. LIPANP. Y No. Z, 28~.9 ..... Date .............. Aa~.S%,. ,2~1,. ., 19.67. ~i~HIS CERTIFIES that the building ].ocated at E/S..Rielmmonc% Road ........ Street Map No. Xxx ..... Block No..X~x ........ Lot No. ~_y,;~..l~ol;~%hOl/i.f .1~,~, ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ,t%lty.-..~t.~. , 1966 · pursuant to which Building Permit No. 3~.63 dated ........ ~'~ly... 20 .... ,1966.., 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~lvat;.e .one..£amlly. d~eiling. ....................................... The certificate is issued to . Alexr~l~.a~'. BDrlde~'ohllk ....... 0.~9~' .................. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department oil Health Approval . l~a:~l%..29.~ .1.~6~...!a.~ Building Inspectork FOI~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMtT MUST BE KEPT ON TME PREMISES UNTIL FULL. COMPLETIOI', OF THE WORK AUTHoR!ZED) et premises located at ' ~ ' · ..~e~c~-.I~a~.-.-:,..~ .................................................................................... .................................. ,~ ¢~tt.t~3~t.~... ~', ~:'~ ~ .............................................................................................. pursuant to application dated ............................. ~;y.....].~f ............. 1966..., and approved by the Building Inspector Fee $ iO...QO. ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Marc~ 29 1967 Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at Rtci~ond Road (Mill Colony) Southol~,N.Y. (Give deed location) have been inspected by this department and found to be satisfactory. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~'.?..Z.~i2 ............. Disapproved a/c ............................... ~::~, ......................................... (Building Inspector) 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 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 sholl 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, ordinances, building code and regulations. ........ ....... ......... (Signature of applicant, or name, if a corporation) ...... (/ ~ (Address of alSplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......... ................................................................ Name of owner of premises ................................................................................................ : ................................ 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 / c~/-zz ~ ~ ~ o IR O Municipa Jify 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 .......... /~...~..,/)Z..~ ....... ~ ........................................................ 3. NatJ Rep( 4. Estir 5. If d, If g( 6. If b 7. Dim Hei.~ Dim, ~re of work (check which applicable): New Building ...?/~ .......... Addition .................. Alteration ir .................. Removal .................. Demolition .................. Other Work (Describe) ~ated Cost .~..~../...5.'/...q.~.?.....ZT..../..~..~....°..°..~. ............. Fee (to be paid on filing this application) ~elling, number of dwelling units ...~'....,~.fY,)~.$.....Number of dwelling units on each floor rage, number of cars ......... ~siness, commercial or mixed occupancy, specify nature and extent of each type of use ;nsions of existing structures, if any: Front ............................ Rear ................................ Depth ht ........................ Number of Stories ~nsions of same structure with alterations or additions: Front .................................... Rear Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions' of entire new construction: Front_ . t ,~ . ,~~..O...~r,(../,M.}~/./....(~..~.(.~.~''~' Rear ...... ..~...~....~ .............. Depth ......~...?...f ..... Height .J...~.~.~... Number of Stories Front/.../.~ ~. t..~.~ ~.~.~..~'. 9. Size bf lot: ..... Rear ...... ................ Depth ....... .............. 10. DateJ'of Purchase ..... ~,~Cz.....~.~.~.~ ..................Name of Former Owner .~' ~ ~ ~ r ~o~ ~ 11. Zone] or use district in which premises are situated 12. DoesJproposed construction violate any zoning law, ordinance or regulation? .......... ~.~. 13. N~m~ of Owner of premises ~.~...~'J~...~.(~.~ddress ...y~..~.~.~.{~ ........ ~..~ ..... Phone No.~g.~.~.~.( '/ . ~, ~~ dd ~'~ ~-- l/~ Name of Architect ..... ~:.~ ....... ~ .............................. A ress ........... ~ ............................... Phone / Nam~ of Contractor ................. Address .......~.~....~L~.5~....~Z~ Phone No. PLOT DIAGRAM Locate ~cie~rly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro~ property lit ,s. Give street and block number or description according to deed, and show street names and indical whether int~ ior or corner Iot~,/~ ~Z/~~ ~ . ................ 21 STATE OF N~W YORK, 1 c c COUNTY OFj ......................... ~'~' (N~me of individual signing application) sworn, above nemed) He is the J (Contractor, agent, corporate officer, etc.) of said ownerJ or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work,will be performed in the manner set forth in the application filed therewith. Sworn to befoFe me this ...................... ,. o, ............................................ ........ ~ ..................... ~ ..~ .... ~otory Public{ ............................................................ County (S}~noturo o{ opplic~nt)