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Home My WebLink About3364-zFORM NO. 4- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. DERTIFIP. ATE BF DBDLIPANDY No. Z 2~9 .. Date .......... Jll~r 2_21.. , 19 67. THIS CERTIFIES that the building located at MidwQod & Eas.twood Street Map No~as/~O°d ~~.II Lot No. ~ ~ts l~k~..C~teho~ conforms substantially to the Application for Buitd~ng Permit heretofore filed in this office dated ~.~' 19 , 19 6~ oursuant to which Building Permit No. .33~ Z dated . j~ ~ , 19 6~, 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 ~lvate o~e f~ily' ~2,i~g ................................... The certificate is issued to A~t~ ~rieoa ..... ~wr ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval J~y 18~ 196~.. ~y R~ .Vi~.. 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? 3364 Z Permission is hereby granted to: ........... G~.Q .,...,~h,].e.r ~,.. JkZ¢.. Az,.tJ~u_~.. Mo,u.'l a,c a to .bu,12.cl... z~e~...o~e...£maL3,y.. 4k~e;L.~la~ ................................................................................... at premises located at [~JJ;..~.....JJlJ~t..~ocKJ..JJSf...Z:[ .................................................................. ................... N:~d~.oo~l... &.. ~'~ ~twac~t ....... ~.~.41o~ t..li.~. .................................................... pursuan¢ to application dated ............................. ~1'~ ........ ~9 ......... , 19~..., and approved by the Building Inspector. Fee $-{.0.00 ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ' (Give"deed location) ~2~' have been inspected by this department and found to be satisfactory. District Engineer~ District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ] 9.....(...Permit No ............................... APPLICATION FOR BUILDING PERMIT Application No. '~ -~ ~ Y INSTRUCTIONS o. Th~s application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildir Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets. areas, and g~wng a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatio c The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Su, permit shall be kept on the premises available for ~nspection throughout the progress of the work. e No building shall be occupied or used in whole or in part For any purpose whatever until o Certificate of Occupon, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of o Budding Permit pursuant to fl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Lows, Ordinances . Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe. The apphcant agrees to comply with all applicable laws, ordinances, building code and regula~tions. (Signa ure of Japplicant, or name, if o corporation) ............... ri- ..... ..... ................. State whether opphcant is owner, lessee, agent, architect, en.~ineer, general contractor, electrician, plumber or builde Name of owner of premises ................... .*.~ .................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and t,tle of corporate officer) 1. Location of land on which pro~osed work w b>edone MapNo .. b~~..~...., lot No. ,~ .................. Street and Number ...... : ....................................................... c~ .................. Munic~pahty 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b Intended use and occupancy .......................... ~. "'~"~':~.,~ ............................................................................. 3. Nature of work (check which applicable): New Budding ¢'~ Addmon Alteration ' ' Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Estimated Cost ..........~../~,..~ .................................... Fee (to be paid on filing this application) ,5 If dweihng, number of dwelling units ................ ~.'. ......... Number of dwelling units on each floor ..../. ..................... If garage, number of cars ................... .J. .................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7 D,mens~ons of existing structures, Jf any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................. D~mens~ons of same structure w~th olterabons or additions: Front ................................ Rear ............................. Depth .............................. Height .............................. Number of Stories ........................................ ' oZ 'z" ........ 8. D~mensions of enbre new construction: Front ............ .~..~. .......... Rear Depth Hmght ........... :..~ .............. Number of Stones I 9. S,ze of lot Front ........ ./..~..?,, ............ Rear'. ........... ~..~.?. ........ Depth ......... ./.?,.77..~ ............. 10. Date of Purchase ....... ..~JT'.~..Af .......... ¢..?..~..~ ..................... Name of Former Owner ..................................................... 1 I. Zone or use d~strict m which premises are s~tuated ....................................... ~.~. ................................................... 12 Does proposed construction wolate any zoning law, ordinance or regulatton? ...../~.~. .......................................... ¢'/ ,,'¢' ~/o¢,/cch. ess /V~-~.~,~u j~ j~L 13 Name of Owner of premises .~.:.....~/. ............................ Addr ............................................ Phone No .................. Name of Architect ...................................................... Address ............................................ Phone No .................. Name of Contractor ..~.¢.~ ..........~...~../.¢~...~.'. .................... Address ...~.~..~?..~..¢.?.~/.~..-- ~' ..... '-----..C,.,%~.~:.. Phone No .................. PLOT DIAGRAM kooate clearly and d~stmctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions frc property hnes Give street and block numbers or description according to deed, and show street names and red,ca whether interior or corner lot. STATE OF NEW YORK, ) COUNTY OF ............................... / S.S. .......................................... be~nfl duly sworn, deposes and says that he s the app c ................ iN'me of indw,dual signing app[~otion) ,~x~/) QDOVe named, me is ne .................................. ~; ...................... : ............................................................................... ~J (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and th~s apphcahon, that all statements contained ~n this applicabon are true to the best of his knowledge and bel and that the work will be performed in the manner set forth in the applicahon filed therewith. Sworn to before me this ( --~ .~....~. day of , 19 ~ 2 ' .................. ....... ..... ................ L (~ I NOTARY i'd~LIC, ,,,~'e of, ~:%'~ V0r~ "J I~o 52 $~,~20 Su.¢x Count] Term Expires March 30,