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Home My WebLink About3512-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFIr. ATE E)F OBP. UPANDY THIS CERTIFIES that the building located at 8/~. ~Pil~e. l~eek. Ilo~ ...... Stree~ Map No. :K~ ...... Block lk!o. lc~[ .......... Lot No. ~ .... ~O~lthO~. ~,~,'.~ ........ conforms subsiantially to the Application for Building Permit heretofore filed in this office dated ....... ~i~te ..... 6 .. , 196~' pursuant to,which Building Permit No...3~2- ~[ dated .......... ~lllt.~e .... [~..., 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 ...P~i~afle. one' Earn&iF .d~)'~ing ..................................... The certificate is issued to. ~fl,3,l&6~.. ~,~i%~etq ..... '(;~%~;s's'e~' ;;' 'ie'x;;~i) ......... of the aforesaid building. Suffolk County Department of Health Approval .... 88Isi;., ~8~. ;1.~6~.. b~. I~t.~ .Vt~- ~ ~ NO. ~ 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? 35 2 Z Permission is hereby granted to: G.¥.~th..&..~..Z~..A~.G.... ~l.l.& .~tl to ~1~...~,~...m .. ~.e,~,~... ~,~,,t~ .................................................................................... at premises located at .~.~11~.1~41~1;.~4~1¢i4 ................................................................................ ....................................... ~u,~,.....loZo .................................................................................... pursua:n¢ to application dated ................................ ~ ....... 6 ........ , 19.~.., and approved by the Building Inspector. Fee $.~J~, {~3 ............ TOWN OF SOUTHOLD tOPERTY ES. 21e LAND 700 SEAS. VL. IMP. V l LLAGE S ~ FARM COMM. TOTAL 70 0 AGE NEW Farm Tillable Tillable 2. Tillable 3 Woodland Swampland 3rushland House Plot NORMAL Acre Total RECORD CARD- BUILDING CONDITION BELOW Value Per Acre DATE REMARKS ABOVE Value DISTRICT SUB. ACREAGE ' / TYPE OF BUILDING LOT Est. Mkt. Value ~':~ ~ x' //7/ FRONTAGI FRONTAGE ON ROAD BULKHEAD DOCK ~xtenslon ~xtension 3arage D.B. Fdundation Basement Ext. Walls Fire Place Patio Driveway Porch Parch ~ ~ Batch /~, /_ /_. [Floors J Interior Finish Heat Roof Type~' jRooms lst~Floor Rooms 2nd Floor iDormer FO~M NO.! 'I~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................ Disapproved a/c ......~~ ...... (Bui ding Inspector~ Application No. ~ '~C~x ~'- APPLICATION FOR BUILDING PERMIT ote ................................. , 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 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 Buildina 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 agft regulations. .... (S'~at e of applicant, or name, if a corporation) (Address of applicant) Sta~ther applicant i~er, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ...................................................................................................................... Name of owner of premises ...~.~,~.~r..~,.~~'.~ ....................................................................................... ~c_or~fe, s,gnoture of duly authorized officer. (Name and title of corporate officer) No..~.~/..~,~,..~. ~ 1. Location of land on which~posed work will be done~Map ' " ... . Lot No.: ~ ..... Street and Number .~....~.~... .................................................................................. Municipality 2. State existing use and occupancy ~o!~premises and intended use and occupancy of proposed construction: b. Intended use and occupancy ........ ~:.~..~..~.-~¢-~r ..................................................................................................... 3, Nature of work (check which applicable): New Building ../.~......~...i.. Addition .................. Alteration .................. Repair ................ ~ Removal .................. Demolition ............... ~ Other ~,~'_k (Describe) ........................................ 4. Est mated Cost .... ,/. ~._.~/.~C~..,.;~[ ................ Fee ........... /....~.. ...................................................................... (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 ........~'"""~"~'""7~"~ 6. If business, commercial or mixed occupancy, specify nature end extent of each type of use 7. Dimensions of existing structures, if any: Front ...:..~a...~'..~.,'~ ....... Rear Depth ~ .... Height ...~./..~.,~Zt ...... Number of Stories ...~ ............................................................................................... Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions o,f entire new construction: Front ...~....~',.~.Zz~.. .............. Rear ..~.~.~..Z'.z-~ .......... Depth .....~...~../=.~.. ..... Height ../...~....x(~/~..C.... Number of Stories ....... ~ ................................................................................................. 9, Size of lot: Front ..~/../..~....~.~..~. ...... Rear ..... ./...~....~...../~..'.ZTT.. ...... Depth ..../..~..~...~..~.. ......... I0. Date of Purchase ........................................................ Name of Former Owner ......................................................... 1 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction viol~e~any~.oning law, ordinance or regulation? 13. Name of Owner of premises~-~'[.<~..,~.,~-,~--m~~7~' ~' (~' ...... Address ............................................ Phone No ..................... Name of Architect .................................................... Address ........................................... Phone No ..................... Name of Contractor.,~....,.. ~..~...~~.Address ..~"~.~.'.. 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 number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEA/YORK, COUNTY OF ................................ .................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing 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 th~s 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 19..~.~ Notary Public, Z}.'.J~.-~.,.....¢.:......./.~,~...?~... County (Signature of applicant) ( ('./ ,~ARION A. R£O£NT NOTARY PUBLIC, State of New York No, 52-3233120 Suffolk County Term Exp res Nra ch 30~ 19~ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date~~ Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a etructure located (Give'deed location) have been inspected by this department and found to be satisfactory. District Engine~'~~'~