HomeMy WebLinkAbout3448-zFORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
P. ERTIFIP. ATK nF OP.P. UPANr. Y
No. ~. ~!672 ..... Date ............ 0CtO~ll~. '~,9' '" 19.
THIS CERTIFIES that the building located at ~q./.~ -Jo(~'- C~eeIr. .I~ ...... Street
Map No. ~ ...... Block No ...... ~ .... Lot No.~.~ou%l~:l(~.-t:,.~, ..........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ...... &ll~'~ · .3 ..... , 1967. pursuant to which Building Permit No. 31~.
dated .......... &l~rl$...h~.-', 19.6~, was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is . P]~vate. (me. £a~i, ly- <~'e:~.1.J~u~ ......................................
The Certificate is issued to . &.~be.d;' '&- ~&~ '~l~m~l~l~ · · '; ' ' ' 011~' ' '.', .........
~owner, lessee or ~;enan~)
of the aforesaid building.
Suffolk County Department of Health Approval .... ~;... ~L~.~. ~..~'}.. ~.,~,.
Building Inspecto~
FORM NO. 2
TOWN OF SOUTNOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
CrHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
3448 Z
Permission is hereby granted to:
at premises located at ....~.~..~...~.....l~...~.~'..e..,....ll~.t~,.4t...jl~J~...]~'~ ..............................
pursuance to application dated ............................... ..~..t...~..],.....~. ............ , 19..~.?..., and approved by the
Building Inspector.
Fee $..],...0. :....(~... ..........
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Da~e
Bldg. Permit No.
TO WHOM IT MAY CONCERN:
at
The sewage disposal facilities for
(Give deed/location)
a structure located
have been inspected by this department and found to be satisfactory.
District Ez~C-~ ~c~-
District Engineer
FOI/~I NO. I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOL~, N. Y.
APPLICATION FOR BUILDING PER,MIT
Date ................. .................... , ....
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 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 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 oil applicable laws, ordinances, building code and regulations.
.........
(A~dress of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Name of owner of premises ....~.~../~..~;~d/~t~¢........~.......~..~..._~...S...,.~...~8¢~....~/r~ ......
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: ............................................ Lot No: ....................
Street and Number ............... ~ .~.~.~.~;'..'6.~./......~./~...~¢..~:~.....~../~../......~ .......................................................................
/ Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy ...... ~.~ ............................................................................
/
3. Nature of work (check which applicable): New Building ...1~........ ...... Addition .................. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
4. Estimated Cost .... ~..].~.....~=-~tr~ .................................. Fee ........... J...o.......u~..
(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 additions: Front ................................ Rear ................................
Depth .............................. Height .............................. Number of Stories ........................................
/
8. Dimensions of entire new construction: Front ...~J.~:. ..................Rear ..... ................Depth .,.~.~...- ..................
Height .......... l..~. ............ Number of Stories .......... ~ ......
9. Size of lot: Front ..J.~)..~..~... ......... Rear ....~/.f).,,~..~... ...... Depth ....~-,.~...~...~..~. ......
10. Date of Purchase ................/-/J'/'~"'b"'('~'~' ................... Name,,.,L_.l_.//of,Former Owner ..(~lm,/,/,'t~.x~',/:...~ .........
' (:7
1 1. Zone or use district in which premises are situated............... ..............................................................
12.' Does proposed construction violate any zoning law, ordinance or regulation? ....~.4~... ...........................................
13. Name of Owner of premises ~,..8~~....Address ..~..~-er~l~.~..,.~.t.. Phone No..~.~...~.~.Z/..~.~
Nome of Architect ...................................................... Address ............................................ Phone No .....................
Nome of Contractor .~...~~ ......... Address .~.~,.~.r.,. Phone No..~...~...~...:~7~*~
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 ................................
............... (N"a'~'~'~-'i~ ivid u~oT dig n i ng application)
above named. He is the ............................................... 'x-~.......~;m~....~....: .....................................................................
· - (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 in the manner set ~orth in the application filed therewith.
Sworn to before me this
....... ....... do, of ......... ............. ........
*~""~_ .~ I/ ,,~ /~.3 ~ ~ ,* ...... ~..,,...,,~s~..~,.~. v,, .~....~...,%~....*,, ...............................
Notary Public, ./~_)~'L~.......c~..:.../.~oynt~ (Signature of applicant) ," Cyf~Y I'll ,, I',',
FORM NO, I
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved ............................. '. .......... , 19 ........ Permit No .... .~..~.~. ·
D[sopproved o/c .................. ~.~.~..~..~. ................ ..~.~. · ..~. ....... :~,~-~ .~. ........................
.................. {; ....~.. ~¢' ~'~'i:'''t'''''':(Bu/ding I "/'"~;~;;i ...............................
Application No....~.~';~..c../..4~';:. ....
APPLICATION FOR BUILDING PERMIT
Date ................ (~....Z .................... , 19 J~..~.. ....
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 (3 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 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·
~ ............'.~.,'.l~fi~..,~.~.. ~' .~ ,~ .....................................
~ (Signature of applicant, or name, if a corporation)
(A~Jdress of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
Location of land on which proposed work will be done. Map No: ............................................ Lot No: ....................
' / Municipality
State existing use and occupancy of premises and intended use and occupancy of proposed construction:
b. Intended use and occupancy .~. ....... ~ ..............................................
3. Nature of work (check which applicable): New Building .../e~.. ........... Addition .................. Alteration ..................
Repair .................... Removal .................... Demolition .................... Other Work (Describe) ......................................
4. Estimated Cost ..... ~.,z'..~.,..~ ................................. Fee ...................
(to be paid on filing this application)
5. If dwelling, number of dwelling units~;,~C:C~.~¢.*t~.....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 ..~O..~ .................
Height ............................ Number of Stories ............................
9. Size of lot: Front ,../.~,.¢,..~., ......... Rear ..... l.~,.~..~,,-- ...... Depth ....~.~...~..~ ......
10. Date of Purchase ................ ,~, ................... Name of Former Owner ..~.~.~kJ ............
11. Zone or use district in which premises are situated,...~<~,~ ..............................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ...~ .~;~.. ...........................................
of
Phone
13. Name Owner of premises /',/.:.~2/;,,~v~t,~,m'.~.c~,...Address
No.
Name of Architect ...................................................... Address ............................................ Phone No. ....................
Name of Contractor .~.~...~0~ ......... 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, ~ S.S.
COUNTY OF ................................
....... . ........................... being duly sworn, deposes and soys that he is the appllcont
{Nome of individual signing application) (~ /~_
abow~' named. He ts the ..................................... ~ .......................................................................................
(Contractor, agent, corporate officer, etc.)
of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file
this applicationj that all statements contained in this application ,re true to the best of his knowledge and
and that the work wil~ be performed in tho manner set forth in the ~pplic~tion filed therewith.
Sworn to before me this ~ ~'3'
Notary p~fi~~.....~.¢...~~County (Signature of applicant)