HomeMy WebLinkAbout3477-z TOWI~ OF SOUTHOLD
SUILDING DEPARTMENT
TOWI~ CLERIC'S OFFICE
SOUTHOLD, N,
r. ERTIFIO~T~- OB' OOr. U~Nr.Y
No. ~. 2~.6~ .... Date ................. ~l~.~ .... 2.~. ·., 1967.
THIS CERTIFIES that the building located at ~A~O~.$kV.0 .................. Street
ap ~o ............. No..~ ........ Lot No..~ ..... ~$~O~- 7~ ......
conforms substantially ~o the Application for Building Permit hereto~e filed in this office
dated ............ A~Ci~.. ~., 19.6~. pursuant to which Building Permit No...~.~.~
dated .............. F~y...9..., 19.6~, was issued, and conforms to all of the require-
ments .of the .applicable provisions of the law. The .occupancy ~or which this certificate is
issued is ,.~.-.~r= ............................
The certificate is issued $o .. ~a~, .6..~.~g~%~ .~e,%ly. ...... 0%~c~S ..............
(owner, lessee or tenant)
of the aforesaid building.
.Suffolk County Department of Health Approval ~1~...~, .~96~- · .by..R,. ~it.ta .....
FOEM NO. 2
TOWN OF $OUTHOLD
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)
Permission is hereby grcmted ,to:
to application ~ ~' '
pursuan¢ doted''Jr ...................... , ....~ ............. , I .,., and approved bY the,
Building Inspector. ~, ",', ·
' Buildin~ Inspector
S-9
SCHD
SUFFOLK
COUNTY DEPARTMENT
Date_
Bldg.
OF HEALTH
Permit
TO WHOM IT MAY CONCERN:
at
The sewage disposal facilities for a structure located
(Give deed location)
have been inspected by this department and found to be satisfactory.
District Engineer
1967
District Engineer
~'v_:~ /~-. ,5o'=/'
FOI~iV~ NO. 1
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
Approved
Disapproved a/c .~ ....
· ' ............ re(Building In:~ct~'"~""~;;i'"' ' ' ~ '"' ' .................
APPLICATION FOR BUILDING PERMIT
Application No. ?...~L.Z...~'.. ...........
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 B0ilding 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 pa rt 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,J~lding code and regulations.
(Sincere of~applicant, or name, if a corporation)
,..~.......~.2.~... ~.~.e...o. ~.~.. ~)..Z.~.~ .,..... k~.~ p..~ .u. ~..e..,....[.~.~ :. ......
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
Neme of owner of premises .....~e.s..~..&..Ma~'f,~.e.%...M,.,.K.e.:~%~ ..............................................................................
If ~pplicen~ is ~orpor~te~ signature of duly ~uthorized officer.
1. Location of rand on which proposed work wilt be done. Map No: ..... ~,~8 .... Lot No: Z~
Street c.d ~umber .....~~...~.~..~x..~..~. ....... ..................................................
~unJcipality
2. State existing use and occupancy of premises c~ intende~ use and occupancy of proposed construction:
a. ~xistin~ use and occupancy ...................................................................................................................................
b. intended use and occupancy ..~Q~..L..~F...d~eZ~ ............................................................................
3. Nature of work (check which applicable): New Building ...... ,,X ......... Addition .................. Alteration ..................
Repair ........... ~ .......... Demolition .................... Other Work (Describe) ......................................
4. Estimated Co~~~.~~ ............................ Fee ..........................................................................................
(to be paid on filing this application)
5, If dwelling, number of dwelling units ......... 1 ................. Number of dwelling units on each floor ............................
If garage, number of cars ......... .1, ...............................................................................................................................
6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................
7. Dimensioos 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 ...... ,5.?. ................. Rear ........ .5.7.!. ............. Depth .....28.~. ................
Height 16 Number of Stories 1
].15 t Rear ......... .]:,.1:.5..! .......... Depth ............ ~/.~5 ................
9. Size of lot: Front ............................ :1.
10, Date of Purchase ........................................................ Name of Former Owner ......... ,qglJ..t:tl ...................................
11. Zone or use district in which premises are situated ........... .~...e.§..i..c!.e..,z!_t..:~fl.~. ...........................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~Q ........................................
13. Name of Owner of premises l~[~.~..&..~aa~8;~tl:~dl:iress ..,~.2.9..,~J,.~,~P.~..~,]-~.~*.. Phone No.
Name of Architect ....P~...l~.e~f:.~l~' .......................... Address ...... ).~.~.8.~.Q. Ia~.~ ................ Phone No.
Nesconset Phone No. 72/*- 1205
Name of Contractor ....~a.y. l~e~'~e= ....................... Address .............................................................
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 says that he is the applicant
(Name of individual s~gning application)
above named. 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 wi be performed n the manner set forth in the application filed therewith.
Sworn to ,b~,ore me this
.......... ~-~ .......... day of ...~..-~..~. ~f ...................... , 19'"~"?'
.-~-, ~ - ,---/,2 ' . ...................... ,,.,,~/....l.,..~..._w;.~..t.....~:.....:; ...........................
Notary Publi ,c~.)'..J~.'l~....7..~~ ........ Co~,~1'6, ^. R?£m' ¢, (Sign~'~e of apphcant)
(~/ NOTARY pUBLIC, State ot,tlew Y
No 52-3233120 Sullolx Cotmt~