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HomeMy WebLinkAbout3710-z~ORM~ l~O. 4 TOWN OF SOUTHOLD EUILDING DEPARTMENT TOWI~ CLERK'S OFFICE $OUTHOLD, No Y. I]ERTIFll]ATE OF rII~I]UI~ANi]Y No. Z30~6 Date April 2~ 19.68 Smithfield Park Map bio ............. Block No ............. Lot No. conforms substantially to the App]icati,on for Building Permit heretofore fried in thls office dated NOVe ~ ~ 1968 pursuant to whlch Building Permit bio. 3710Z dated NOVe ~ 19.6..8 was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy f. or which this certificate is issued is .. ~r..~y,a. ,%e. ,9.n,c,, ,f.a.m, .~.~.~..a.;?.o.~.~..~.g ......................................... The certificate is issued t.o .~.,%?...8..nl.i.~..h..&.. ~.o..n.s.I..~.~...0.w.17..e?.@ .... ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health App.r~oval .A.p?..i.]: .... ~..~. fi..9.6.8.. ~.y...lq... .y.~.l..1.a. ..... House # 1~+0~ TOWN OF souTHOLD 'BUILDING DEPARTMENT TOWN CLERK'$:~OFFICE SOUTHOLD, ~'N. Y. NV 3710 Z Permission is hereby granted to: BUILDING PERMIT ' (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ................. ~.m~,~.~ .............. L at premises located at ..L~t..~,$. ...... ~,~.£',Lel~..g~ ........... ,..:.; ...... ~ .............................. : ......... ................................. ¢& ~,..,:~ ~.~,:.. ~,.~, ~-, .............. ~o~,.~j~o:t,,~..,,....., .................................................... pursuo:n¢ to opplication doted ................................. ~-...,1..~ ....... , 19t~..., ond oppro¥od b~ the Building Inspector. ,Fee $.~,~ ........... ' ' Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH APR 2 2 1968 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 Engineer District Engineer FO~,M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ? ,OUT.OL,, N. '~'~ 19 ....... Application No. ~ 7/a Examined ......................................... · ........................... ~reved ........................................ , ]~ ........ Per~ ~o ................................. 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 public 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 a Building Permit to the applicant. Such permit shall be kept on the premises available for inspe.ction throughout the progress of the work. e. No building shall be occupied or used in whole or in part For any purpose whatever until o Certificate of Occupancy shah have been granted by the Building Inspector. ' APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant' ~}o the Building Zone Ordinance of the Town 6f 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 oil applicable laws, ordinances, building co~ons. (Sigr~tu[~f~fap~plicant, or name, if a corporation) (Address of applicant)~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................... ............................................................................. Name of owner of premises ............. ~'.~..r. ......................... : ....... , ................................... ' ........................................................... If applicant is a corpora~~horized o~fice[. ............. ('l~me ar~d title of corporate officer)~/ 1. Location of land on which proposed work will be done. Map N ',~./..'~./~./,~. ~/~'/..1~...~. ~.....~?.~. ~JiJ-ot No: ........... Street and Number ..~~...~ ................ i...: ............ : ......................................................... Municipality 2. State existing use and occupancy of premises and inten~ded use and occupancy of proposed construction: a. Existing use and occupancy ..... ~~ .............................................................. ~ ................. b. Intended use and occupancy ~ 3. Nature of work (check which applicable): New Building ....~..., ........ Addition .................. Alteratlon .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ..,~...~...~.~..~.. ..................................... Fee ..... ~ .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...,~.rh~ ........... Number of dwelling units on each floor ............................ If garage, number of cars ...... ~,~. .............................................................................................................................. 6, If business, commercial or mixed occupancy/~sDecify~,nature and ~fxten~ 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 .....7.l ................. Rear .~..~.. .................... Depth ~.,......~ .............. Height..~.,.~,...~ ............... Number of Stories ..... ~ ............. 9. Size of lot: Front ~..~,~S2 ............... Rear ....~....'~...?'. ............ Depth ~.~....~...: .~....~-- ' ~ -- ~ '~/~O~":~:~:~'~ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ I1. Zone or use district in which premises are situated....~-~ .................................................................................. 12. ~emS p~:~,~de CoOfn~t:eUmCtiis:~l~.e~~:AOdr~;zc~.~~..~....:....~:.~: ...................... 13. e r ' .. .' .... : ............................................ Name of Architect,m__ ~'~ /~ ~ *~-~---~x .......... ~ ..................... Address ........ s~ .......... ,..~ ....... ; ......... Phone No ..................... Name of Contractor/~2¢.. ~/..¢~.~....~..~.......~..'~......Address~~ ......... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ c c COUN' ' OF ................................ ' .................. being duly sworn, deposes and says that he is the applicant .............. (N~o~r-'lh~d?v~cT~/I sigh'lng application) above named. He is the ..................~ .................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is d~ly authorized to perform or have performed the said work and to make and file this application; that aH 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 ~ore me this ~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ , 19... Application No. / ~) Approved ........................................ , 19 ........ Perm t No....~ ............................ D sap~roved a/c .............. ,.....7. ................. ~.,~. ......... Z~. .......... ~,~ ~~_ ,,. ~,~. ,~ (Building Inspec 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 premises or public 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 hot be c~mmenced before i'ssuance 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. ordinances, building code an.~regulatio~s. ~Fhe applicant agreestocompiywithallapplicable laws, ~-t~' ~ ~~~~ (Signafure ~pplicant~or ~ame, if a corpor,at'o ) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................... .............................. (Name and title of corporate officer)~ 1. Location of land on whic~h proposed work will be done. Map Ne~...~.~..~.~?....~.,.~....~....?..).~...~./r(ot No:..~.~... ........... Street and Number .................................................................................................................................................. Municipality 2. State existing use and occupancy of.~e~mises and intended use and occupancy of proposed construction: a 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 ,.,~.. .~..~,c~,,~. ..................................... Fee ..... ~ .............................................................................. (to be paid on filing this application) 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 aad't'ons: 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 ~..~....~...~..,~-.~--" "~ ,/'7~'¢~-'~'~'"*'~'~ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated.....~D,~,..,¢ .................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ..../(~...~ ............................................. 13. Name of Owner of premises .~;.~...~,¢,~,,~'~'hAddress ...,,~~ .......... Phone No ..................... Name of Architect ............................... ~ ..................... Address ~ ...... ,...,.~ ............... Phone No ..................... Name of Contractor/,~'~.,.~/,~~ ........ Address ,.~r~,,~. ......... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) S S COUNTY OF~ ...................... // /~'~., . ~... be na du v sworn de oses ond sa s that he s the o icont ....................... ,~. ~.~.~ ~.~.~,.-,~t,-~ ........................ ~ ~ P Y PP *bovo homed 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 b~performed in the manner set forth in the application filed there~th. Swomto before me this~ ........ ......... ............. p~, ....... . ..... ~..~~ ............................