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Home My WebLink About3714-zFORM NO. 4 TO~VN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN C~.ERI~'S OFFICE SOUTHOLD, N. Y. OEI;tTII:'IEIATE OF OI]IDUPANi]Y No. Z .3.1.1l '.. Date .............. ~.%119.1~ ..... 12 .... , 19. ~8 · Hm C~T~FmS that the buiidlng located ~.t .~/~ ..0~e..~i.e~..~.V.e. ........ Street Map Nc~.l~..~.t.h..f.~'.e..]'.cl. g~Jl[ No ............. Lot No..1.~. ..... ltollt;hoJ, d,..~.,X, ........ conforms substantially to the Applieati.on for Building Permit heretofore flied in this office dated ' ....}IO.~,. ~.0 ........ 19. ~ pursuant to which Building Permit No. 37J.~...~.. dated.. ......... ..~OV ............ 20 , 19.67, was issued, and conforms to all of the require- menSs ,of the applicable provisions of the law. The .o,eeupancy ~or which this certificate is issued is .. ?.~..~.~.a..%.~.. 9.11..0...i'.a.I~. !.~.~' ~.~.0~. ~.g ...................................... The certificate is issued t,o . .~toll.& .I~a~ga2o~ .~1~'I1~ ........... 0~/~a0I'-~t ...... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~.a.}/'...~.].,..1.9.6.8....~y...R.,..~. ~l,~.Ig .... .~!~-~/.': ':. ............................... " Building Inspect~ · TOWN OF $DUTH~LD-~ ' · SOUTHOLD, , :, BUILDING PERMIT PERMIT MUS'I~ BE KEPT ON THE 'PREMISES UNTIL FULL ~OMPLETIoN OF'THE WORK AUTHORIZED) Permission' is hereby granted to: to~e..,.e~..e~,e:.~..~,~:~.~ ....................... :L; ...... ~ ............................... : .................... at premises located at ~4~..'j, Jl~J..~t, J3i~,..~e,~JJ~ ........ -....' ...... ~ .............................................. .................................. :~/.,~...Cl.~ e~.~z;t,e~.. ?.v.e ......... ~°~t,~o~ .................. L,2 .............................. pursuon¢ to application dated ......................... Jj[~j' ....... ~ ............... , 19;.tj,~.,__ an~l approved by the Building Inspector. ', .Fee $~LOei~.... JJ ........ ~uddlng inspector s-9 SUFFOLK COUNT~ DEFARTMENT OF HEALTN Date,, Bldg. Permit No. '~/Z/, ~ 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 En,gine e r "District Engineer' FO~ NO. ! TO~N OF $OUT~OL~ BUILDING DEPARTMENT TOWN ~LERK'S OFFICE SOUTHOLD, N. Y. Ex(3mined ...2.~.~ ............ , 19..~.~ ........................................ , ~9 ........ Permit No ........ D~s~pproved ~c .....~~ {Buildin~ Impo{tot) App',c t,on ......... APPLICATION FOR BUILDING PERMIT Date NOV 20 19....~.~. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and sQbmitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premi.ses or public streets or areas, and giving a detailed description of 1(3your of property must be drawn on the diagram which is p~rt 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 (3 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 (3 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, housing code, and regulations. (Signature of applicant, or name, if a corporation) ............ · W.:L.]: .].m a.z- t, !~ · · A.'~ e ....... G~,ee ~o e-~ t. ........................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................. C.a~t.~a.c .t.a:~ ....................................................................................................................................... Name of owner of premises ....~,~.~.QD,..~....~..~-.~,~'~'.~.~'.,..~..t....~..~...~. .......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ~.~.~.~...~.F~.... Lot No.: .~ .................. Street and Number .... .~.~.~.~.~.~..~Y.~ ........... ~P~.~ .................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propos~ construction: a. Existing use and occupancy ...... ~¢~...~.~ ................................................................................................... b. Intended use and occupancy ....O~e..~..~ ............................................................................... 3. Nature of work (check which applicable): New Building ...~ ..... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost .....2.~.~.0...0..0. .......................................... Fee ..... .]....0. ................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .....O.b.e. ................. Number of dwe[ting units on each floor ............................ If garage, number of cars ...........O..~..e....~....~. ....... i .......................................................................................................... 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 a.lterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... 65 ........................ Rear .....68 .................. Depth ....2.8 ............... Height .................... Number of Stories ..... One .......................................................................................................... 9. Size of lot: Front ....'I~1. ................. Rear ..... ],01 ........................ Depth ........ 2~)0 ................. 10. Date of Purchase ........................................................ Name of Former Owner ....... S~l.th..~Z'~S ......................... 11. Zone or use district in which premises are situated "A" dist 12. Does proposed construction violate any zoning law, ordinance or regulation? ................ ~,,Q ....................................... 13. Name of Owner of premises ,,l~J,~t,l~..,'Q..'Re~.e .......... Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~..~...~,J,,~,~ ................................... Address ............ .Gr.e~e~9o~.~ .......... Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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 NEWyORK ~ c ¢ couN'r¥ OF ............ .................................... J~s~D~..D£az .................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) abow~ named. He is the ..................... ~.9..~...t..~..a..9.~.9.~ ............................................................................................................ (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 ~hat the work will be performed in the manner set forth in the apR, t~ation filed therewith. Sworn to before me this [ I .................. ~0. day of .............. ~O.~..~.~f~. .......... , 19...~.. (,/,~-~,~,~ ~ ~)~ ,~' z ~ ~, ~ ~ , ......... C .z.z...~'. .......................................... Notary Public,~~.~......~. ....... .~.4.~County ~'"'~'"'~" (Signature o~nt)