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Home My WebLink About3706-zFORM 1~O. 4 TOWN OF SOUTI~OLD BUILDING DEPARTMENT TOWN CLEEK'S OFFICE SOUT~OLD. N. Y. ~ERTIFII~ATE ElF OP. IDUPANP. Y No.~, .30.9.0 ..... Date .................. ~.~,~ .... Sbt .... 19.6.8. THIS CERTIFIES ~hat the building located at ~/~... ~.~]-~..P. ¢~. ~.D~ ...... Street Fo~dh~ Acers Block~o. .Lot No. 11 ...... .G~e~npo~:..N..Y. ........ Map No ............. conforms substantially t0. the Application for Building Permft hereto~oTe filed in this office dated ......... I~O= ..... 13 .... ;, 19.6~, was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .o~cupancy for which this ce~ificate is (owner, lessee or tenant) of the afore.said building. .Suffolk County Departmen! of Health Approval .... M~y. · · 1 $ · · ~.9~ · · by. R.~ -~].la. · · FOlh~l NO, :~ TOWN OF SOUTNOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERbIIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF' THE WORK AUTHORIZED) 3706 Z Permission is hereby granted to: 0 ,...?.e.~eii..~.'.C .. ~.~t ~.. i,/~ ................ ............... e~e=rp~ ........................................... to .~.ai3A.. r~z.~...ar~ ~., far~X~...~,,~il/x~g, .................................................................................. at premises located at ~,~.~...~!~, [,.~t,~?,~ A~.e.~L..s~e....% ........................................... ............................... /h~.~...~&.,~e .......... ~ee~e~t~ ............................................................... pursuan,t to application dated ............................. ~0~-~.....~ ........... , 19./~..., ond approved by the Building Inspector. Fee $.~,0~00 .......... ' Building Inspector SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give d~ed location) have been inspected by this department and found to be satisfactory. District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit ~o ................................. D[sopprovod o/c~ .................................x.:..~~~ ............. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 pubJic streets or areas, and giving a detailed description of layout of propertymust 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 o 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, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... C~o~ .~'.~e.'l~ o ~. ................................................................................................................................................ Nome of owner of premises .....,g.g..°...~.f:..~...~' G.o.,,~.q.fl,Y. .................................................. if applicant is o corporate, signature of duly outhorlzed officer. (Name and title of corporete officer) 1. Location of land onwhich proposed work will be done. Map No: .....?.~.:~.V~ ..............................Lot No: 11 Street and Number ..... ,r.~M~,.1,...~?.~ .t.... t~ ~:.~..g... ~: ....m~ fl ..... .cp. v ~ .................................................... Municipality 2. State existing use and occupancy of premises and intended use 6nd occupancy of proposed construction: a. Existing use and occupancy ............. .~.~.t..~.~.(?.L.~4.~..?..1..°..~ ....................................................................................... b. Intended use and occupancy ......................................................... r. ...................................................................... 3. Nature of work (check which applicable): New Building ~c.~.~.c ........... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4, Estimated Cost .........:.~,~.:~.~.~.Q.~.)..*. ................................ Fee .......................................................................................... (to be paid on filing this application) ............................ Number of dwelling units on each floor ...??~.?. .................. If dwelling, number of dwelling units one If garage, number of cars ........ ~'<.r.~.~. ............................................................................................................................ 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 aad't'ons: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ........................................ 8, Dimensions of entire new construction: Front 'q~;~ ~" Rear ~()~ ~" Depth ~,'.t.~ ~" Height ] q~ .............. Number of Stories ~rr~,~ 9. ~ize of tot: Front ~0 ~ Rear ~0~ Depth ~D0 ~' 10. Date of Purchase ...... ~.~ ......................................... Name of Former ~ner ..~?.~.~...~9.~.9.~ ......................... 11. Zone or use district in which premises are situated ................................................................................... ~ ............. 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... D.9. ............................................ 13. Name of ~ner of premises ..S.C.Q~.~..~..~.c.B~.~.e~Address ...~.~D.9.~B..~.~...~., ........ Phone No. ~.~.~... Name of Architect ....~.~ ......................................... Address ............................................ Phone No ..................... Name of Contractor ..C.....~......~Q~.e[~ ........... ~ ........ Address .. G.=ee.~no.~¢~ ~ ~, ~. PScnc b~c. ~,~...~.~.~ LOT DIAG~M Locate clearly and distinctly all bui~gs, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block ~bers or description according to deed, and show street names and indicate whether interior or corner lot. ~ SmA ' OF ¥OR , S.S. COUNW OF ................................ ~ ~ ................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) 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 ~re true to the best of his knowledge and belief; and that the work will be per~ormed in the manner set forth in the application filed therewith. Sworn to before me this ........... !.~. ........... day of ...... Notary Public, . ........................................................... County (Signature of applicant)