HomeMy WebLinkAbout4046-zTOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
OE:RTIFIP. ATE: OF OCCUPANCY
THIS CERTIFIES that the building located at .i~e~l~.~, .Kerry ~,4 .... Street
Map No..~ ....... Block No.. ~ ...... Lot No. ~ .... ~O~ho~d...[[,~. ........
conforms substantially ~o the Applicati. on for Building Permit heretofore fried in this office
dated ............ gept...16.., 19~. pursuant to which Building Permit No. I~)~...
dated ....... $Spt ...... 16 ...... 19.~., was issued, and conforms to all of the require-
ments .of the .applicable provisions of the law. The occupancy for which this certificate is
issued is ... l~T~.~ate, olde. £am:l, ly. dw~ll./~g ........................................
The certificate is issued t,o ~]l~OIl.d, .~dO .......... O~q~l~ .........................
(owner, lessee or tenant)
of the aforesaid building.
.Suffolk County Department of Health Approval ...~v~l~.. ~..1~...bit..R,..V$.~.~...
Building Inspector
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, No Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 4046 Z
Permission is hereby granted to:
.... .G~l~u~t~..&.~mm..Zne.,.. ~/g..~yma~l liLIr~do
to . ~..~...~ ..~ .~.~.z..~...~ ..................................................................................
at premises located at ..... ~:~..~,di...d~...Wel~..,JblL ..........................................................
pursuanrc to application date~' . ............ ..IO.~.~. ......... .~.~ .............. , 19.~1~.., and approved by the
Building Inspector.
Fee $..10.e~ ..........
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Date ,Y~r~?; 29, ]969
Bldg. Permit No.
TO WHOM IT
at
MAY CONCERN:
The sewage disposal facilities for a structure located
Cor~er ~errv Pd. a~ Wcs~n~
(Give deed location)
Sout?o~d? S m~tbo].d
have been inspected by this department and found to be satisfactory.
District Engineer
District Engineer
FORM NO.
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE ? ~,~
SOUTHOLD, N. Y.
Approved ........................................ , 19 ........ Permit No. /'/0 f-~ ~
Application No......~.....b....~...~. .......
APPLICATION FOR BUILDING PERMI/T/
Date .,~...Z..~.~..//X~ ................... ,
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 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 Deportment 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, ordin~ct~ces, building cocle~.and regulp~tions.
,~ v (Address of bpplicant)/
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Nome of owner of premises ............................................................................
If applicant is corporate, signatur of duly a orized officer.
(Name and title of corporate officer) ~'
1. Location of land on which proposed work will be done. Map No.: ..................................... ~'Lot No.b. .......................
Street and Number .......... : ....
Municipality
2. State existing use and occupancy of premises end intended use and occupancy of proposed construction:
o. Existing use and occupancy ....~.~ .................................................................................................
b. Intended use and occupancy ...... ~..~~ ........................................................................................
3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................
4. Estimated Cost ..... ,~....~.~...~5....~..~. ............................... Fee
(to be paid on filing this application)
$. If dwelling, number of dwelling units ....~'...~.Number of dwelling units on each floor ....-z .......................
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 alterations or additions: Front .................................... Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ..... ~...'~.~.. .................... Rear ..~.~.. .............Depth ....~......~. .............
Height .~..~.'...( ........ Number~ of Stories ..... ~......; .................. ~ ........................
9. Size of lot: Front ...../....~.....~. ............ Rear ......... ./....~...?.. ............... Depth ...... /...~ ............
10. Date of Purchase ................ ~ ................................. Name of Farmer Owner ..~ ..............................................
11. Zone or use district Jn which premises are situated ..... ~ ..............................................................
12. Does proposed construction violate/~),~ ~-z,~.xjany zon~d~inance~ or regulation? ...... ~~ .............................................
13. Name of Owner of premisesu:..,ee~:r4m..,v¢. .............. !....Addres~.../~A~..~../.~Phone
No
Name of Architect ..................................................... Address Phone No .....................
Name of Contractor,/~J..~...~..:.~~...Address iii~iii~ii~i Phone No .....................
PLOT DIAGRAM
Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil 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 YORK,
COUNTY OF ................................ )' ""' ~/ .,7
(N me at inaiviaua~ s~gning applj,cation}
above named. He is the .......... ~ ......................................
(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 before me this