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Home My WebLink About3470-zFORM NO. 4- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. ERTIFIE:ATE OF OP.P. UPANP. Y THIS CERTIFIES that the building located at . ~lOZ~. 11~I~ ............... Street Map No. s,~ ..... Block No..]~ ........ Lot No..]~ . . .~0~O~11tl. · ~[,Y~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... I~a~' ..... I~ .... , 19 6~ pursuant to which Building Permit No. · ~l~70' dated .......... l~_'~r .... l+ ...., 19(~;. , 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 l~l~,~te .Olde..fa~-l.y. ~l~'elling ....................................... The certificate is issued to .. C~.I~]. ~;at.l' .......... ~t~1t~' .......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . 8epg...I~. '1~?..by. 1~ .'~:l,l.l~.. Building I~~ FORM NO. 2 TOWN OF SOUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL PULL COMPLETION OF THE WORK AUTHORIZED) ?, N? 3~70 Z Permission is hereby granted to: ............ .~$.~..e....~.~.~.~...M..~.....~r~...~.~ · ~. ,, ...,~.~..~.,.~, . . to ~I~.~..I~i~P~...~e.'. ~.~.. ~ ~L~J~ ....................... : ........................................................... at premises located ct ............................................................................ ;,.;,...;.....~..;..~ ..... -, ................ '..' ......... ~ ........ , ............ ,~---,------- ,," ..~.~.~:..~......,..~ ................................ . .................. ~ ....................... pursuant to application dated .............................. ~...; .................. , 1~...., and app~oyed by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da e Bldg. Permit No. TO WMOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Gi~d deed l~tion) ~ have been inspected by this department and found to be satisfactory. District Engineer,,. FOI~M NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE' SOUTHOLD, N. Y. Application No....~....~.(.2..q ........... APPLICATION FOR BUILDING PERMIT Date ............................ ~a,~.....~. ................. , 19...~2 .... 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 s~reets 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 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 'l'own 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 oH applicable laws, ordinances, bui ding code and regulations. Eugene Horton (Signature of applicant, or name, if a corporation) New Su££olk (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises ..... ~.,~.,r,,3.;..~.~.~,i?. ....................................................................................................................... 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.: XXX XX ........................................ Lot No.: ........................ Street and Number ...~hOZ'.t~..~O~C]. ....... .~.l~.~.¢.~.9. g~. ............................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....v~aaz:~.~..Z~tt& .................................................................................................... b. Intended use and occupancy ....... .o.~.e....~.~]~....cl:.?,.e.Z...~.$.~..g ............................................................................ 3. Nature of work (check which applicable): New Building XXXX Addition Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost 2~ 0OO P/.~ Fee 3.0 (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .o...:rt...e. ............... Number of dwelling units on each floor ............................ If garage, number of cars ....... 2...9. f~. .......................................................................................................................... 6. If business, commercial or mixed occupancy, specify nalure and extent of each type of use ............................ 7. Dimensions of existing structures, Jf 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 ......... ~..~.'...~ .................. Rear ....... ~;.~..':~. ........... Depth .....2..8...-.6. ........... Height .................... Number of Stories ...~..~.o. ............................................................................................................. 9. Size of lot: Front ...... ],~.0. .............. Rear ..... ~,.0.Q ........................ Depth ........ [~.Q ................. 10. Dote of Purchase ........................................................ Name of Former Owner .....¢.ft~.~ .......................................... 11. Zone or use district in which premises are situated ......... t.l,~.l.I......~.~...~..~. ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ 13. Name of Owner of premises ..C.~.~....~.~.~,$~. ............... Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor J~l~t~r,~;0.e,..~[o.,x.i:;p~ .................... Address ...~;~¢..~q.~,f.~pJJ:;~ ............... Phone No ..................... PLOT DIAGRAM kocete clearly and distinctly alt buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street ond block number or description according to deed, and show street names ond indicote whether interior or corner lot, STATE OF N~ YORK, } c c COUNTY OF ..... ~.O~ .......... J~'o' ~ugene ~[oz ¢o~ h~ ,~ duly sworn, deposes and says t~at he is the applicant (Name of individual signing application) abowe named. He is the ...................~.~.~.~.~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 ond 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 forth in the application filed therewith. Sworn to before me this ................. ..... ................... .............. . , .............................................................. Notary ~ubli~.~.....~..~....l~:~oun~ - ~ (Si~noture of opplicont) ~ NOTARY PUBLIC, StaL';- ]erm Expires Harch 30, 19~