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Home My WebLink About4062-zFOEM 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. P.E:RTIFII-I. ATE: DF rlP. rI. UPANP. y No. ~ ..... Date .............. '~F~.~" .l~ ....... , 19. THIS CERTIFIES that the building located at ..... C~'e&l~t~'&~ ......... Street Map No. ra':[l"~"~ .p~,k No ............. Lot No. ~9 ...... ~tt,]~,d ................. conforms substantially to the Applicati.on for Buildin~ Permit heretofore filed in this office dated ........ S~'IJ{; .....~0 ..... 19~. pursuant to which Building Permit No.. dated ....... {}ep~ ..... 2~ .... , 19.6~, was issued, and conforms to all of the require- ments .of the applicable provis}ons of the law. The occupancy f. or which this certificate is issued is .. Pl. lVat~ · 4}~' l'a~'~'Iy' 'cl/~'ii~ng ......................................... The certificate is issued t.o ..~. ~Olql$1~ & ~(~er, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ' '~pl'~.].' '~' '$~'' ~' R~'V~J.~ ..... TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, Y. BUILDING PERMIT CI'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~062 Z Permission is hereby granted to: ..... ~.,...~.,...~..~....~.....~.~.,~. ~....~.e...tt at premises located at ...... ~..~I.....~{~'~M..J~ .................................................................. ................................... e~ee~e~.~ ....... le,~A .................................................................. pursuan¢ to application dated ............................ ...~. ~..~ ....... J~l. ......... , 19....~..~., and approved by the Building Inspector. Fee $.~l{~,d~) ........... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM at IT MAY CONCERN: The sewage disp. gsal facilities for a structure located (Give deed l~ca~ion) have been inspected by this department and found to be satisfactory. FOI~WI NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEI~T TOWN CLERK'S OFFI(~E SOUTHOLD, N. Y. ×amined ..... ....... , Approved ........................................ , 19 ........ Permit No. j~/ ~) 6 ) ~ Disapproved o/c ....~::>. ~ .~.:~; ...................................... ................................................................ ....................... ............... ' ................ .............................. Application No. /~( 0 ~ ~"~[~ APPLICATION FOR BUILDING PERMIT Date '. . O , 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, relptionship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be dra~n on the diagram which is port 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 j~urpose whatever until o Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Department for thel issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of 5outhold, Suffolk County, New:York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, o~ for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances, building code and regulations: ~ (Signa~L/fe of applicant, or nome, if o corporation) ............... ......... ~ (Ad d~l/s~ ofJ~6pplicant) ' State whether applicant is owner, lessee, agent, architect, engineer, .general contractor, electrician, plumber or builder. Neme of owner of premises ......... ~..~,'~,-~ ................................... ............................................................................ tf applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) h Location of land on which proposed work will be done. Mop N ~'~.. ,~t&~ ..~.~. Lot No.: ~..-.~.. ............... Street end Number ........................... i ...... ' ................. 2. State existing use and occupancy of pre~mises and intended use and occupancy of proposed construction: o. Existing use an' occu~ ~n~ . ..~..~..,d pa cy .......... C,-.~] ................... :~ ............................................................................ b. Intended use and occupancy ........ ~-~.. ..................................................................................... 3, Nature of work (check which applicable): New Building ..... ./~......,.,.. Addition ..................Alteration .................. Repair .................. Removal .................. DemoHtian .................. Other Work (Describe) ........................................ (to be paid on filing this application) ,5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars .......................... .,~'~..; .............................................................................................................. 6, IF business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions 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. Dimensions of entire new construction: Front .......... ~,..~ .................. Rear ......~.fl ................ Depth ....,~..~ ............ Height ....... ./../~. ...... Number of Stories ,.. ..~. .................................................................................................... 9. Size of lot: Front ..... ~..,~...~... ........... Rear ......... .~...~,.~1~:, .............. Depth ....... ~,..-~.~..,.,.~T. ..... 10. Dote of Purchase ....... ./..~..~.~ ................................... Name of Former Owner ~.....: .............. 11. Zone or use district in which premises ore situated .......... ~,~ ...................................................................................... 12. Daes proposed construction violate any zoning Iow~ordinance or regulation ............................................................. -- 13. Name of Owner of premise ..:.~.~,...Address .i'.~/..:.rf. : ...... Phone No.~:.~.C:.,.~.'.,~, .~../ Name of Architect ......................................................Address ............................................ Phone No ..................... Name of Contractor ..... .~../...~..~ ....................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~'3RI~' ~f( 'lc ~ COUNTY OF ........ ..................................................... ' ............................... ~ ~ ~ duly sworn, deposes end says that he is the applicant (Name of individual signing o~licotion) ...... , c1' 0, ( ,, above (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 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.b~fo~e me this r ,... ............... ~a. 52~323312~ Sufi~l~ Term ~p~es ~ch 30