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Home My WebLink About3460-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFIP, ATE OF DIZIIZIUPANI-:.Y No. ?-. ~:~9~ .... Date ........... 0etobel,. · 26..., 19.67. THIS CERTIFIES that the building located at l~v~,..l~sd. Map No.. xx .... Block No .... x~ ...... Lot No. m ..... 8mltho'~l' · N':Y~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Diay .... 2" 19.67 pursuant to which Building Permit No.. 31+60.Z dated ............ lz~y .... 2' '" 19.67' 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 Prl'vt~t~' 'one' '?,~.mlg.:y ' d~z'~llidk~'g ........................................ The certificate is issued to 'l~emli~' i~tise~' ................................ (ow~e~see or tenant) of the aforesaid building. Suffolk County Department of Health Approval . OCt...1.gr. 1.967..-by. P~, .¥it.1~- - FORM, NO; 2 TOWN OF SOUTHOLD '~BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3460 z Permission is hereby granted to: .~..o...~.~.s.~.....~c...~.em~.~..~. ...~i ............. ~..~t~.~.i ........................................ Building In?pector./ ..o...,:~ .... Fee .~.. .............. SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Dage Bldg. Permit No. ~/~ TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (~i~e deed location) have been inspected by this department and found to be satisfactory. District Engineer FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c ....... ~'D ........ "~ ............... ~ ..................................... APPLICATION FOR BUILDING PERMIT .................. ......... .... 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 adioining premises or public streets or areas, and giving a detailed description of layout of property must 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 o 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~oi. applicant, or name, if 'a corporation) (Address of applicant) State whether applicant is owner, I ee_~a ant architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .. ~ .......................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No.: ~ ~ Lot No' ~"~ Street and Number .~..~......O~.. ....... ...~..~........~...~.....~Z..~ ......................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: · g o o p y ...................................... :.~ .......... ~ ....................................................................... b. ,ntendeduseondoccupancy ........ ~:...~..~¢~.: .......................................................... 3. Nature of work (check which applicable): New Building .................. Addition "~'q'/~I~-................. Alteration .................. Repair .............. ~. Removal ..... ~ ............ Demolition ............ o ..... Other Work (Describe) ........................................ Estmated Cost ~'.,~?. OeJ ~ 4 ......... ,,. ................................................ r-ee .......................................................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelJing 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 ................. ,.~......Nu_mber of Stories ................................ 8. Dimensions of entire new construction: Front.~~ ....................... Reor.......~....~.. ............... Depth "~¢~°t- Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ....... ..,.~_~,.....~ ....... Rear ........... Depth ~ 10. Date of Purchase ....... /~...........,,......-- ............-..- ....., c]~, r,u. rr~, ? ~ '7' ............ N~'"~'For r"(~,~"~i~~~ '' 11. Zone or use district in WhiCh'premises'are'situated'"'"..~....~. ................ "'"'"'"'"'"'"'"'"'"'"'"'"' '"' '""'"'"'"'"'"'"'"'"'"'"'"'"'"'"'-' 12. Does proposed construction vi~;~l~t~ an, y_zoJ)~g law, ordinance or re,~ulatio ~, ~ 13. Name of Owner of premises ~...(~...O~....'.~..z...~,.Address ..... ~~i?iiiiiiiiiii"~'~"~i'iiii'.i'.iiiii'.iiiiiii Name of Architect ...................................................... Address .................. ~z,,.~ ................... Phone No ..................... Name of Contractor .................................... ~ ....... Address -~,~-.~ r~ Phone No. PLOT DIAGRAM I_ocote cleorly and distinctly all buildings, whether existing or proposed, and indicote oll set-bock dimensions from property lines. Give street ond block number or description according to deed, ond show street names and indicate whether interior or corner lot. ,,~,,~ STATE OF NEW ~V~RK..~../I~I~ ~ ¢ ¢ COUNTY OF .,..~~fl~...$ .... , .................................................................................. z .............. ae ng duly sworn, deposes and says that he is the applicant (Name of individual signin9 applicati~) above named He s the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized ~o perform or have performed the said work and to make and file this opplicat~on; that all statements contained in this application are true to 1he 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 before me this ................. · o, ................... ~ f4AR~0~ A ~0TARY PUBHg, S[~t~ ~[ i~w ~0. 52-3233120 Suffolk ~[~ ~xpir0s March 30,~g,