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Home My WebLink About3384-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. m.I:'RTIFIP. ATE: DF 131]I:UPANI]Y THIS CERTIFIES that the building located at ]~/t~ ]~ ~hlft~O].k ~ .................. ~:': .......... Street Map No.. ~ ....... Block No .... ~ ..... Lot No. ~ ..... ~[l~Ch.o.g~l~.....~..~.~.: ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ~ch ~. 19 67 pursuant to which Building Permit No. 33~1~ Z dated ............ .]~..r.?.h....~ .... 19..6.?, was issued, and eon£orms to all of the require- ments .of the applicable provisions of the law. The occupancy for which this certificate is issued is P.~i.v~.te-elle. fami. ly. dwelling .............. Walter Te:eesko Owl~x' The cert/ficate is issued t,o .......................................................... (owner, lessee or tenant) of the aforesaid bmlding. Suffolk County Department of Health Approval . April 6~ 1967 by R.Villa TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~ BUILDING PE~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3384 Z PerMission is hereby granted to: ............... ~,.e.~..~,e. ............................... to Budding Inspector / 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 have been inspected by this department and found to be satisfactory. District Engineer " District Engineer 1~o~ ~o. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ..................... ~.~ ................ , 19 ........ Per.it ~o ..... D,sapproved a/c ..... ~¢~..~.~....~.....~....u,~~-- ........................... ...... .... ............................. (Buddmo Insp~'r) Application No. '~ ~ ~- ~ APPLICATION FOR BUILDING PERMIT Date ~--c.'~-- c~k_~ i , 19...~...Z... INSTRUCTIONS o. Th~s opphcation must be completely filled in by typewriter or in ink and submitted in duplicate to the Bu~ldinL Inspector. b Plot plan showing location of lot and of buildings on premises, relahonship to adjoining premises or public streets o, areas, and gwmg a detailed description of layout of propertymust be drawn on the d~agram which is part of this applicabon c. The work covered by this apphcat~on may not be commenced before issuance of Building Permit. d. Upon approval of this apphcation, the Budding Inspector will issue a Building Permit to the applicant. Suck permit shall be kept on the premises available for inspection throughout the progress of the work. e No budding shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupanc~ shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of o Building Permit pursuant to th- Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construction of buddings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply w~th all apphcable laws, ordinances, building code and regulations. (S~gnature of applicant, or name, if a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder Name of owner of premise, ....... ..... ........................................................................... 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 ..............~t~....:.~.~..,, ................................. .'~R ..................................................................... -~ ~ Municipality J State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ......... .~....0.:/..~......~...~.~,. ....................................................................................... b. Intended use and occupancy ................................................ ~ ...................................................................... 3 Nature of work (check which applicable)' New Building ................ Addmon .................. Alteration ................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4. Estimated Cost ........... ..&.....~..~...~.~..~..,..?~. ..................... Fee (to be paid on filing th~s apphcation) 5 If dwelhng, number of dwelling units ........... /. ............... Number of dwelling units on each floor ........................... If garage, number of cars .......................................................................................................................................... 6 If bus~ness, commercial or mixed occupq, ncy, specify nature and extent of each type of use ............................... 7. D~mensions of ex~sting structures, if any: Front .......................... Rear .......................... Depth ........................... Height ............................ Number of Stories ............................................................................................................. Dtmens~ons of same structure with alterations or addmons: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8 D~mens~ons of entire new construction' Front ............................Rear ............................ Depth ........................... Height ............................ Number of Stones ............................ 9. Size of lot. Front ......... ./?. ............... Rear ......... /..fro ............. Depth ....../...-~...~.. ............... 10. Date of Purchase ........ ./.~.~..>~. .................................. Name of Former Owner .....-~......~Y....~....~:~..'~....J~.. ............. 11. Zone or use d~stnct in which premises are situated ................................................................................................ 12 Does proposed construction violate any zoning Law, ordinance or regulahon? ..................................................... bkj ~.~....jj~,~_~ Address 13 Name of Owner of prem,ses .......................................................~ ....... *" i~' ................................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor .................................................... Address ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fror property hnes. G~ve street and block numbers or description acfordmg to deed, and show street names and ind~cat whether interior or corner lot. / duly sworn, deposes and says that he is the opplic~ STATE OF NEW _'_Y~OR'K~..~, ~[_ ~ c c COUNTY OF .... ............ ~~..:.: . ..' .............. bemng (Name of m&vidual signing apphcatmg9) 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 th,s application, that all statements contained mn this application are true to the best of his knowledge and bell and that the work w~ll be performed in the manner set forth in the apphcat~on filed therewith. Sworn to b~Jare me th~s~ __ _ ....... Notary Pub',c, ~.¢.:~C~.~,,,...~~ .... Co~}3 ........ , (Signature of applicant) ~ N~ 52 32~.L.0 S.,,ofk C~untv . ~erm [xplres ~arch