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Home My WebLink About3501-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EiERTIFIEIATE OF n[31-:UPANP. Y No..~.. 2~(3~t.,. Date ............ .(kI~,obel'.. ~.1~.., 19.6~. THIS CERTIFIES that the building located at G]-o~e~'. St..&. ~l~keF. ~... Street Map No. ~ ...... Block No...~ ........ Lot No. ~.. l~tikio~,dt. ~.e~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ,~'ar~e .... 2.. , 19~'~.. pursuant to which Building Permit No.3~)l..~. dated ~'ur~e 2 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.V.~,f~..~e. f,~z01!,~: .dYe~l~g ........................................ The certificate is issued to .Jose.Dh. Sabe~a...&. Wife ....... 01lief ................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . .O.e.'C, ..~...lc~,.~...~..R,..Villa .... Building Inspector FOF~.~ NO. ~ TOWN O1~ SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUIi'DINGr PERMIT : CIFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3501 Z Perrnls~ion is hereby grante~l 'fo: to Southo!~ ~,~, pursucn~ ~o ~pplicotion 'doted'. ............. ..~ ........... ~.L....~ ........... , ]g.~..., ond opproved by the Building Inspector. Building nspector ~ SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da.re Bldg. Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure (Give deed location) located have been inspected by this department and found to be satisfactory. Distz'io~ District Engineer V At. Approved ........................................ , FOEM ~0, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19 ........ Permit No ................................. Disapproved a/c ~. ............. (Building Jnspector~ Application No...,~......,~,.,O...( .......... APPLICATION FOR BUILDING PERMIT Date ....~.L~./g.,---------~...~ ................................. , 19.~...~..... 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 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, building code and regulations. (SignOre of applicant, or,,fame, if a corporation) ..... (Address of apphcant) State whether applicant is owner, lessee,, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. .................................................................................................................................................. Name of owner of premises ~,....~,~,,.~ ........... ~/~.~.-...:~,.,..~.....~.~,:~ ............ 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 ~/~?..~..~..~.~..~...~,.4.~,...~.~.~~. ................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~. Existing use and ~cupancy ..... ~...~R.~.....C.~. ...... ~.g.~ ......................................................... b. Infended use and occupancy ...... ~.~... ~z ...... ~ ............................................................ 3. Nature of work (check which applicable): New Building ......./.... ...... Addition .................. Alteration .................. Repair ................ .~ Removal Demolition .................... Other Work (Describe) ................................. '~ '"~ ............... Fee . '~ZO, gO.. . 4. Estimated Cost /.~.1.~..~.~....~'. ................................................................................................................. (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 .~.~...C~...~b~...~....~.~.~..~¢.~..~4.~.~.~. 6. If business, commercial or mixed occupancy, specify nature and extent of each Wpe of use ........ ~ ................. 7, Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth Height Number of Stories ~ ~f~ ......................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ . Depth .............................. Height .............................. Number of Stones ...~.~ 8. D~mens~ons of enhre new constrSct o~: Front ............. ~ ......... Rear ...~.~ ................. Depth .~. .................. Height ......... / ................ Number of Stories ..... ~ ..................... 9, Size of lot: Front .~.~.~.~ .......... Rear ....... ~ .................. Depth ..~.~¢..~.~ ....... 10, Date of Purchase ........ 3..,Z~.....~.~ - ......................... Nome of Former ~ner ...~.~. ................................. . ..... , , ......................... 11.Zone or use district in which premises are s.tuated .... ~ 12. Does proposed construction viotate any zoning law, ordinance or regulation? ..... ~. ......................................... 13, Name of ~ner of premises .Z~,~.....~.~.~...Address ..~;~.~,,..,..~,.~ .............. Phone Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ~.~...~.~.~ .......... Address .~...~r~:~¢...~.~.,. 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 NEWARK, ~ e~ -1¢ ~ COUNTY OF ................................ f~'o' ......... ~.~.~.....~...~.~h~ ............................ being duly sworn, deposes and says that he is the applicant ............................................................................. (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 app ication; 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 n the appl cat on filed therewith. Sworn to beene me this ~ ~ ~ . ~ day of ..~'~~. , 19..~.7 ~ .... ~ _ ...................... ........ ......... ' ........................ . y~ . . Notary ~ubl.c~ .....~~~.....,~t~,~ f~b~of ~,~ Yor~ ~ (S.gnature of applier)