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Home My WebLink About3671-zFOI~M ~0. 4 TOWN OF SOUTHoLD! BUILDING D£PARTMEN~ TOWN CLEI~K'S OFFICE SOUTHOLD, N, Y. P,E~TIFIP. ATE BF' [3P-P.I~II~ANCY THIS CERTIFIES that the building located at .t[t/l~ j. ~1~1~. ~d ........... Street ~p~ ~o. Creek ............ ~ocK ~o ............. ~ot ~o. ~..: ...... ~0.~t..lm!d....~..~, ........ conforms substantially ~o the Application for Building Pdrmit heretof~re filed in this office dated ............. I,)C.~ .... ~.., 19.6~ pursuant to whidh Building Permit No. ~(>.~.]. ~. dated ......... 0..~.~. .... ].~ ....... 19.(2~., was issued, and conforms to all of the require- me.nts ,of the applicable provisions of the law. The .occul~ancy f.or which this certificate is issued is . ]P~.iva~;~..O1~. fatall.y. ~1I~,3.1.il~:lt .......... !~ ............................... The certificate is issued ~o .... (o~vner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ...l~e~...2~,..~...l~y..R~..V.t~[ll~ .... TOWN Cm-ERi~S omC~ ' $OUTHO~D, N. Y. BUILDING PEIU~AIT (THIS PERMIT~ MUST BE KE?T· oN THE PREA~I~$ UNTIL COMPLETION OF THE WORK AUTHORIZED) N? 3671 Z -Dote.,,.....~.: ....... k~ ...... :ill......, ,9..~ Permission is hereby granted, to: ..... ~ ~ to ...~.)~.X.~..a~...~...l~r ..~,m~.~ .................... : .................. , ......... ,...,, ........................ ........................ ala.....~..~a ....... ~.~....:., .................................................................. ..................................................................................... ~ ............... ~ ......... ~..~.~..: ........................................ pursuon,t to application dated .......................... ].....~[~t$ ......... ~i.:,..,.., 19.~..., and approved by the Building Inspector. .Fee $. ,.,~.0..~ .~. ........ ',. s-9 SUFFOLK COUNT~ DEPAFd~MENT OF EEALTH ~e 1",4A¥ 2 8 1968 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a s~ructur~ located at (G{ve deed location) .......... have been inspected by this Department and found to be, satisfactory. D~ 3trict Ehgineer Examined 19..'. ..... FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMEN'I TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No .............................. Application No ............................. Disapproved a/c/ ........... ./~.....~.~[7::~,,. .............. .'~.;~t:.: .... ................................................................... : .................. ......... .i. (Building In~ector) APPLICATION FOR BUILDING I~ERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ihk 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 g v ng a detailed descr pt On of layout of property must be drawn bn the diagram which is part of this application. c. The work covered by this application may not be commenced befor~ issuance of Building Permit. d. Upon approval of this application, the Buitding Inspector wilt issueio Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progr~s of the work, e. No building shall be occupied or used in whole or in port for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the i~suance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, and other app cab e Laws, Ord nonces or Regulations, for the construction of buildings, additions or alterations, or {or removal or demolition, as herein described. The applicant agrees to comply with all apphcable Wows, ordinances, budding code and regulations. (Signature of applicant, or nome, if a corporation) ...... o tb. ....................................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, genera! contractor, electrician, plumber or builder. Name of owner of pre. mises ..JDo~-I./L.Dt[.C~OZ'~o~ ............................................................................................................. If opplicent is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ]. Location of lend on which proposed work will be done, Map No.: ,~..~l~...~..-~..r?.'~.~.....~..g...~. ...... Lot ~o.: .~. .................. Street and Number .~, ,~ ~O¢~ ~.Q~Q~ '. Munici~lity 2. State existing use and occupancy of premises and intended use and occupancy of propos~ construction: a. Existing use and occupancy ........ .~[,~.(~'~...}.g~. ..................... ~ ......................................................................... b. Intended use and occupancy ........... .~D...~'.~Z..~O~ ................................. ; ..................................... 3. Nature of work (check which applicable): New Building ....~.....:~.. ....... Addition .................. Altero.tion .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~J~u~, ................ Number of dwelling units on each floor ............................ If garage, number of cars ............. ~,~l'D. ......................................................................................................................... 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 ................................ Height .................... Number of Stories ....q,t~,9 ........................................ ~ ................................................................... 9. Size of lot: Front ......... ................... Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ................ !!,i~Z~...¢l.&~.~ ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~ .............................................. 13. Name of Owner of pr.emisesD~"t~..~L.O..i'.f~O~;t~tr~Z:.....Address ............................................ Phone No ..................... Name of Architect ...................................................... Address Phone No ..................... Name of Contractor r~.oj~¥z..,JX~o~:l.a ...................... Address ...... ~..~O~,C~ ................... Phone No ..................... ~ PLOT DIAGRAM Locate clearly and distinctly/all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give stree{ and :block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW ~ORK, COUNTY OF . u'~ome o~ ina~waua] s gmng oppucar on) ~ , (Contractor, agent, corporate officer, etc.) of said owner or owd~rs, and is duly authorized, to perfo;rrn or have performed the said work end to make and file this application; that all statements contained Jn this apRlication are true to the best of his k:i~owledge and belief; end that 'the work will be performed in the manner set forth inthe application filed therewith. ,' Swam to before me this ., _., ? , / --4- ¸4' / / / / / / .i~.- : ,_ 0 L,. P aA J -i 0 ,' i J J ,,, ]