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Home My WebLink About3816-zFORM I~0. 4 TOWN OF SOUTHOLD BUILDING DEPAtlTMENT 'I'OWN CLEI~K'S OFFICE SOUTHOLD, N, Y, r. EI~TIFll]ATE OF or.r. UPANOY No.. Z~.~P~ .... Date ............... ~eb,...28 .......i969. THIS CERTIFIES that the building located at . .~.S...N&~I. P~O&~. .......... Street Map No.. '~A~ ....... Block No...~ ....... Lot No..~ .... 0~le~lt...l~,~, ............ conforms substantially to the Applicati~on for Building Permit heretof, o~e filed in this office dated ............ 4~.~0~i'l..~ .... 19.69 pursuant to which Building Permit No. 3~$6. ~ · dated ........... ~4)~i.~....~ ..... 19..~9 was issued, and conforms to all of the require- ments ,of the applicable provisions of the ~aw. The .occupancy ~or which this certificate is issued is ....~l*t.V~;e · olde. 'i:am~ty' ~t.~tl~ng ........................................ The certificate is issued t,o . ..tt, l~.~Ol~e .~eper~ozl~i' &;Igi'i'etowner, ....... ]essee01~31or '~nant) ~'~ ............. of the afore.said building. .Suffolk County Department of Health Appvoval. F. e1~...26~. ~)69...b~ .R.,..Vi.~l&. ..... FOI~M 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? 3816 z Permission Is hereby gronted to: at premises located at .~...~{l~,;~..~..~.~......r ............ ~ ...................................................... ................................. OrJ. e~....~,,~, ............................................................................................ ~.,.. pursuan¢ to application dated ............................ ~p~l, ...... .e~ .......... , 19..~, and approved by the Building Inspector. Fee Building nspector { S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Februar~ 26~ 1969 Bldg. Permit No. 3816Z TO WHOM IT MAY CONCERN: The sewage disposal at N/sideM~in Rd (Dive deed Orient ~ So:~thold facilities for a structure located location) have been inspected by this department and found to be satisfactory. District Engineer District Engineer TOWN OF SOUTHOLD/~'' ,~'-~..~/~o/~ t~,'('( BUILDING DEPARTMENT ~ ,-_ _v_"~":-- I~.' TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No. Application No....~......0c~.~/.~.. ........... Disapproved a/c .............................................. APPLICATION FOR ,UILDIHG PERMIT Dote..~......./. ............................. 19...~......~... INSTRUCTIONS a. This application must be complefely filled in by h/pewriter 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 Ioc,ation. c. 'rhe 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 Certificat~ 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ......... .......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .... T..~.. ................ : ............................. .~..~i~.~.~.-....-.-..-.-.-.-. .............................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~)~m'~'''~' ~ ,,~ ~'. I~),,.~,~,~ ~_~' 1. Location of land on ,which proposed work will be d,~one..Mop N~..~[ ....... : ............... ]......R.... ~ No: .................... Street and Number .~~.....~,......~Z...6..Z~., ............................... :,.....: ................... Municipali~ 2. State existin0 use and ~cu~ncy of premises and intended u~ and ~cupan~ of p~ c~struction: ....... ............. , ............................ ........................................ .......... .............. 4. 5. 6. 10. 11. 12. property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or ~orner lot. Nature of work (check which applicable): New Building ...... ~ ........ Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... Estimated Cost ........ .~.....~.. ~... ~')~3~'.. ........................... Fee .......... ~...u...¢....~ ............................................................. (to be paid On filing this application) If dwelling, number of dwelling units ......../. ..................... Number of dwelling units on each floor ............................ If garage, number of cars~ ........................................................................................................................................... If business, commercial or mixed occupancy, specify nature and extent of each type of use,.., ........................ Dimensions of ~structure~, if c,~: Front ........ .~.....~..... ....... Rear ......~.....~....'~.. .......... Depth ...... ..~......~.. ........... Height .....~,....~...'. ........ Number of Stories ..... ~ ........................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ Size of lot: Front ..... /. ........ ~ ....... Rear .../..~,,..~T....~ ....... Depth ..../...;~..~i...~....~ ...... Dote of Purchase ....~..-:.-.../'..~'.-~-.'7. .................. Name of Former Owner ~'...~.~ .......... 7erin or use district in which premises ore situated ..... ~ ...... ~. .......................... Does proposed construction violote any zoning law, ordinance or regulation ..... ~ ....................................... Name of Owner of premises~.:.~..~'X..~:.~ess ....~....~.....~..: ...... Phone NO ..................... Name of Architect ....................................................... Address ..................................... ~......Phone NO ..................... Name of Contract0r...~..~.~:(~.'....Address ....~..~.....y:Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from ....... ~,,~A,....~.'. ........................ beiqg duly sworn, deposes and says that he is the applicant (Name of indi~d~ing bpplica_tion)~ '., ' . 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 i0 the manner set forth in thee ppplicat~,on fi~ t~erewith. Sworn to before me this - ("- ?~,~ ~, f ' . 19 ~ - (S nature of a 'cant) ........................ day o ................................................. g PP Notary Public,. ........................................................... County