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Home My WebLink About3911-zI~OR~ ~0. 4 TOWN OF SOUTHOLD, BUILDING DEPARTMENT ~I'OWN CLERK'S OFFICI SOUTHOLD, N. Y, BE~TIFIE:ATE: rIF 131~E:I. IPANP. Y THIS CERTIFIES that the building located at l~.:~g!l,l~lS, .l~i~.~t0 ............... Street conforms substantially t.o the Application for Building Permit heretofore filed in this office dated .......... ~..u.n.e....J:..l,~ ..... 19.{5.8. pursuant to which Building Permit No. 3.9~, ..g.. dated ......... .~.~.rl.~... jl.l, ..... 19..~8, was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to ...49~.C.O~lc,el~,O ........................................ (oWner, lessee or tenant) of the aforesaid building. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD ' BUILDING DEPARTMENT. TOWN CLERK'S OFFIGE SOUTHOLD, N. ¥. BUILDING PERMIT : (THIS PERMIT MUST BE KEPT ON THE PREMISES COMPLETION OF THE WORK AUTHORIZED) 3911 Z UNTIL FULL Permission is hereby granted to: ...C~,~!o~e;;L.... ~,tC,....~A~,.C~=,~;e~,I~ .... ................ ~e~n~o~r.~ ....................... ; ................. to pursuon¢ to application dated ............................. ~i~.~[[.e.....?*~ ....... !i...., 19....~..~.., and approved by the Building Inspector. Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH RECEIVEO 1961] ~tJ6 I 5 [[~] fO: O 1 ;':'"'A[',T:IENI' OF HEALTH Date Bldg. D~cs~ber 6, 1968 Permit No. 391lZ TO WHOM IT MAY CONCERN: at The sewage disposal facilities for (6ire deed location) ~ Creeunor% ~ S outhold a structure located have been inspected by this department and found to be satisfactory. BLr~lde~ C. W. 'owe,]] ~£sltr~ct ~ng~neer TOWN OF SOUTHOLD -.BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ....... , Approved ........................................ ~// I~ , 19...~.... Permit No............................. Disapproved a/c~ ~ ..................... ..~ ........................... Application I~1o ............................. APPLICATION FOR BUILDING PERMIT Date 19.~..(~. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and ~ubmitted 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 ~s 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 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, housing code, and regulations. (Signature of applicant, or name, if a corporation) (Address of ppplicEnt) U State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................................................. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) ~....~.~ .~....'~..?..."~'... 1. Location of land on which proposed work will be done. Mop No.: ... ~ t No.: ...~...~. . Street and Number .... ~.~.....~...%..~...~"..~~.-- ' ~ ....... ~.~ ................ 2. State existing use and ~cupancy of premises and intended use and~cupancy of prop~ can~mchan: ~ b. I~ use and ~cupancy ........................................................... ~,~...~' 3. Nature of work (check which applicable): New Bu'ilding .................. Addition .................. Alteration .................. Repair .................. R,~rnoval .................. Demolition .................. O~er Work (Describe) ........................................ 4. Estimated Cost ......... .~.~.;..~ ..............i .................. Fee .................. .~..0...~.. ............................................................... (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 same structure with a.lterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ S. Dimensions of entire new construction: Front ......... ~..(~ .................... Rear ......... .~.~ ............. Depth ....~...~. ............. Height ..4~..~). ........... Number of Stories ......... I.~.~ ............................................. :~ ...................................................... 9. Size of lot: Front . .~.....t~...~..~.... Rear .................................... Depth .../~...~'....O.~....o~... .... 10. Date of Purchase ........................ ~..~.~. .................... N~eopf Former Owner .~...~ ......................... '11. Zone or use district in which premises are situated ........ ~..~....~...(...~.....'~... ................................................................ 12. Does proposed construct on v o ate any zon ng law ordnance or regulation;) ~ 13. Name of Owner of premises ..~ ............. Address ....~../-x~..~'~ ....... //~........ Phone No..~'~.~...'?..~.Y.~.{~ Name of Architect ~ ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~.....~¢/..j~.~ ..................... Address ..~-/~w~tt~.....~....~ ......... Phone No. ~.~}.Z..°..~.,~'''' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether i~terior or corner lot. STATE OF NEW YORK, COUNTY OF .......... ...................... J'~'~' ........... ~./,'~'.........~)~ ................................ being duly sworn, deposes and says that he is the applicant (Name of individual si,gn~p_l,i,i~_ti~n) above named. He is the ....... ~ ................................................................i .................................................... (Contrc~ctor, agent, corporate officer, etc.) ~,~f said owner or owners, and is duly authorized to perform or have performed the sa d work and to m~ke and file t~i~ application; that all statements contained in this application are true to the best of his knowled e and belief' and .~n~e work will be performed in the manner set forth in the application' file~l therewith, g ' ~ ~',wom~'~o before me this -- ..... day of ....................... . u. x.. ; ............ ............ ;N~tary Public,-~...~...)~3,~..~<( ....... ./...~.x~,w~L.. County (Signature of applicant) · IIJ~/~ION A. REGENT , NOTARY P~IBLIC, State of New York No. 52-3233i20 Suffolk County ]'a'm Expires ~/[arch 30,