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Home My WebLink About3496-zFORM NO. 4- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. ERTIFI~-ATE: ~nF' OP.P. UPANP. Y No. Z2967 ...... Date ............Dee2~ .........., 19. £7- THIS CERTIFIES that the building located at . It/grid..P~abb~.t.l.~ne ...... Street Map No...xx ...... Block No... ~ ....... Lot No.x,~... F, est. l~e~-:tort~- -- 1¢¢'. · .... conforms substantially to the A'pplication for Building Permit heretofore filed in this office dated .........~a-y-. - - .3.1 , 19 67. pursuant to which Building Permit No..31,96g.. dated ........gay' ' · $][ ...... ,19 67" was issued, and conforms to all of the require-. merits of the applicable provisions of the law. The occupancy for which this certificate is issued is . .~.r~..vate. one. £a~tl.y..dve&,],l, ng ...................................... The certificate is issued to . A.l. frec} .$eh~l~tz ....... q)'~ne ....................... (owner,~essee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...0c.to-1¢.-1~67.. b.y .~l,. Building Inspector FOItM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOV/N CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3496 Z Permission is hereby granted to: ...S..~.~.~.d....g~.L.[~?.. ....... ~....~ e~' ..~.~...~.~ ................................................. ...,..~.,,~.,. ............................................................... ~Id new one f~il~: dwe~l~11~ of prem{ses {ocated at ....~.{ .................................................................................................................. ............................................ .~.a...s.~...}.~r..!..~.~..~ .... }L..~ ,. ..................... [ .................................................. pursucm to application dated ................................... .}.i.~.[ ....... 3..~......, 19...6..~.., and approved by the Building Inspector. S- 9 ? $CHD SUFFOLK COUNTY DEPARTMENT OF HEALTH OCT I 9 ~9§7 Da£e Bldg, Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ~ / (Give deed location) f have been inspected by this department and found to be satisfactory. D~s~tmco t~ngino ~.r District Engineer TOWN OF SOUTHOLD BUILOING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ~ 19.....~."..Permit No...~, ./':/ q~ ~ Application No...,~...~.../r~.~ ........... APPLICATIOI~ FOR BUILDING PERMIT ate ... ................................... , ......... INSTRUCTIONS a. This application must be completely filled in l~',¢~pewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot pJan showing location of lot and of buildmgs on p remises, relationship to ad]oining 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 a:pplicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupiedor 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 and regulations. (Signature of applicant', or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................... ........................................................................ Name of owner of premises ..../.?.~..~(~..~?......~...(..(~f~.~..(I.?..~ ...................................................................................................... If appJicant 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"~'..~l~../..~....~...Y./~..~.(.r./.'~..~[...~.~.'...-- ~.~' ?i....~..-~-....~...(/..~(.) ~'i:../'~/.~.~./..?..~'. ............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .... ~. ......... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ....'~..../.~.~.?..?. ....................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units .._,,O,,~.~ .................. Number of dwelling units on each floor .....O..,~'...~,. ............... 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 ....... ..~...O...'i,O.. ............. Rear ........ ~..?.Z.?.. ........ Depth .....2...~.;.~ ............... Height ...../..O..~.~ .............. Number of ~rones .................................. 9. Size of lot: Front ....... /.??. .................. Rear ........ ./../.~..'.~ ......... Depth ...... .~...~......~...../..o..~ .......... 10. Date of Purchase ~v/'9~¢~ z ~: ? Name of Former Owner J4~'~r ,rc'/t~,~,~ ....................................................................... ~}; ~;;2 '? .~,.. ,p;~. :f~;~,~ .~, ..... ] i, Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ......~...o. ............................................ 13. Name of Owner of ,, _ .................................................. r ............................................... Phone ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....~..~!:..g...~.~..~..~.....~..~..,F..(.~...../..~..r.. ......... Address ..({~!.'.~.~.~..~'...~'.:'!.~.. ............. Phone No. vet'S' PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fram property lines. Give street and block numbers or descriptiad according to deed, and show street names and indicate whether ir~terior or corner lot. STA'I'E OF NEVi.YORK, ) JO~,~*t.*~ S,S. COUNTY OF ............................ ) ................................................................................................. being duly sworn, deposes and says lhat he is the applicant (Name of individual signing application) above named. He is the ............... .c..t.11.r.~;?.c..Z!'.f. .................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform ar have performed the said work and to make and file this application; that all statements contained in this application are true ta 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 .............. .......................... ,Z2 q' ........ . .............................. Nofe-ry Public, . ............. (./ ........ :..-..c~....'r ............... ~e..~2-~!~; , .~f~/ ~ignature or appdcant)