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Home My WebLink About4158-zFORM IVO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. r.E:RTIFICATE: OF nr.r. UPANr. y No. ~. ~.491 .... Date ......... Ma~.. 2.6, .............. 19.69. THIS CERTIFIES that the building located at W. est:~oo~l .Lane .............. Street Map No. gas.tern.. Block No ............. Lot No...7.0...Gr.eenl~r.t,. IR,¥, ......... Shores eonfoms substantially to the Applicati, on for Building Permit heretofore filed in this office dated ....... D.e.q~[~....2.~.,., 19.~5~. pursuant to which Building Permit No..4~5.1~ .~. dated ....... I~.cl~...2~.~., 19..68, was issued, and conforms to all of the require- ments of the applicable provisions of the la~v. The .occupancy f. or which this certificate is issued is . .. 1~.~. SY.~.~..0~.~. ~.ly. ~we~l,ltng ........................................ The certificate is issued to .... JCmeph.aazlle ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval A.p~c.:~]...~,..],96.~,. ~Qb.qXt..V~J,],~ ...... ..... ............. t~il~'i~' ~nspector .... ~, House % 695 Westwood Lane F~re Under~riters % 734584 FORM NO. ~ 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? 4158 Z Permission is hereby granted to: ........ .l~.t .. ~.~....,~..~mm~..Inel.~ .......... ~3,..ll,...¢lem~ .,l~m ................................. to .....~ I~L ~I~E..I~IL ~l~...~ ~ ~ .............................................................................. at premises located at ..... ~t~...~)..J~t,i~..~c~,~l~..ltea..~-T.~ .............................................. ................... I~e~emi../~me.... a~ ...... I~.1~.~ .................................................................. pursuant to application dated ............................... ~.~. ....... ~*~ ......... , 19.6~.., and approved by the Building Ins~ctor. Fee $....'J.O.*.(~ ........ ......................... i~;iiiiillii.%~ ....... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. District ~nginee~ District Engineer L ~,~ ~ 07' O0~ · ,,': ,.,,:.:.~ ,.~Z.Y,z~V~"YE"ZTJ FOltM NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved '' 19..:..'... Permit No. Disapproved ~ ............................................................ ................ ............. ........................ Application No. 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 pram sas 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 rathe 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, ordin~ations. (Signatur~of applicant, or name, if a corporati~'r~) " State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ......~..~...~...~,~.~ ....... . ./..~...,~"~.~..~..~.. ......................................................................... If applicant is a co~orate, signature of duly authorized of{icer. (Name and title of co~orate officer) , 1. L~ation of land on which proposed work will be done. Map No.: .....~....~..~o~o.: ..~ ............... Street and Number ~' '~"~ '~'~e'~'~.~;.~...~....~ 2. State existing use and ~cupency of premises end intended use end ~cup~ncy of propos~ construction: a. Existing use and ~cupancy ~ ~ ........................................................... 3. Nature of work (check which applicable): New Building ...~. Addition .................. Alteration .................. Repair .................. Removal ..................Demolition .................. Ol~her Work (Describe) ........................................ 4. Estimated Cost ....... ~ ....................... Fee ...... !.~.~. .............................................. ~:J[i~!..,".i;,.." ........ (to be paid on filing this application) 5. If dwelling, number of dwelling units .......... j ................ 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 ........n;~.~,m~. 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 ....... ,~.~-~,D~.~'),TZ ........... Rear ....... ~,,.~., ........... Depth oo. .......... Height ....~.~/ ...... Number of Stories ......... 9. Size of lot: Front ...... ././.~.~.-~C... ....... Rear ...... ,~../...,~..-~..~ ............... Depth ...... 7,.~.--~......~ ......... 10. Date of Purchase ...... ./..~..~...~. ............................... Na.me of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......................................................... 13. Name of Owner of premises . .%,~.0.&.~?~,~../~,~hTJ~.Address Nome of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ...~.~,./-/,,~./..C~w.~,~./.~,~..Address J..~4.~J~T~c~.l/..l_j~_,e/fa~/~hone No.7.~1,../.~.~ PLOT DIAGRAM Locate clearly and distinctly all 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 Y~T,K~' t~L~ ~ S S (Name of individual signing application) - - ~, above named. He is the ........................... ~...~i.~...~;,~.~..~ .................................................................................. (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 tru%to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the appljLc~t~/n ~ilgcl therewith. Sworn to he~=ezne this ,,~ / . / / ,/ ............. of ....... ............ , ............. MARION A, REGEi~'I~ ................ NOTARY PUBLIO, State of J~Jew Yor~ No. 52-3233120 Suffolk~lCounty~ Term Expires March 30, 19._.~ 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 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 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, ordin~and re~, ulations. J (Signatur~'of applicant, or name, if a corporation) (Address of applicant) State whether applicant Js owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises-.'~".~..~..'?=--~-.-4 ....... /~.-.-~-.'"~"'.¥.....~-.--.~--.. ........................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. L~otion of land on which proposed work will be done. Map No.: ....~.....~.~.~ ...... Lot No.: .~ .................. ~/ -- ~ ~ ~E~? WO~D LANE Munici~li~ 2. State existing use and ~cupancy of premises and intended use and occu~ncy of propos~ construction: a. ~ st ng use and ~cupancy ~ 3. Nature of work (check which applicable): New Building .. . Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ...... ~:.~,~ ........................ Fee I 0 ~' ~ .......... .................. 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 alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ ! .'~-~.~.../~Z'.,~, ....... Depth ....~...~...../. .......... 8. Dimensions of entire new construction: Front ...... ..~..,~...../~. ........... Rear -- z Height ..~....~.. ......Number of Stories ........ ~ ................ . 9. Size of lot: Front .....././...,,.~... ........ Rear ..... /.../....~....-~... ............... Depth ...... ./...'~........-~.. .......... 10. Date of Purchase ..... ,/..~...l~..~... ............................... Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction v o ate any zen ng aw, ord nonce or regu at on:~ ,L;/' "~;;',;'~'~ 13. Name of Owner of premises ~.~.~..~.Z~...~.,~Z.J.~_~.Address ,/..~....~.'.../.~...~.~. Phone No.~,'~.;Z.~....~.~.~',.,~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor~.~;~.../~/. ~.~. ..~..P..4~Z.~/..-~..~.. ....... Address,~,~.~..--..~../~.~..~..././. ......... ...3m'..l~...~/.f~//Phone No~..~..~..../.~.~ PLOT DIAGRAM Locate clearly and distinctly all 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 Y~)I~K,~/· /~ '1¢ ¢ (Name of individuol signing opl~icotion) . /~ ~ 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 end file this application; that all statements contoined 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 applic~ot4c~fil~jd ,therewith. Sworn to before me this ./~~ / I / /,' ~' .............. . t r ay of .......... .......... . _ Notary Public~--~.~....~.~:l~).N~' County .......... '~"~'~" '"~' (~;;¢' ;;~plicant) .......... F]OTARY PUBLIC, ~'tat f New Yor~ ................... Term Expires M, arch 30, 19JIz~ b 1 ~ , , ' d ~Zb!4 N, t. STALE 1{-' I d