Loading...
HomeMy WebLinkAbout3386-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E:ERTIFIP. ATE OF' FIP. E:UPANI-:.Y No. Z 2'~60 Date "' -,~%tl,~r -2b,- · -. , 19 6y THIS CERTIFIES that the building located at E/$ ~%r&i~has Pa~ .. Street Map No~ Block No. ~ . Lot No. ~ B~l~" 'N Y ......... conforms substantially to the Application for Building Permit heretofore filed ~ this office dated ~ ~ , 19 ~ pursuant to which Building Permit No~386 ~ dated ~h. ~ , 19~V , was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is i sued is ...................................... The certificate is issued to .................................................. DaVid ~e~ (owner, ~or tenant) of the aforesaid building. Suffolk County Department of Health Approv~ J~Y 19~ 1967 by R, Villa FORM 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? 3386 Z Permission is hereby granted to: ............ A ~ ~..~ ~.. ~.if~.e.~ .....~.g......~&~..~..,.. ....... lO.....~e.]r3.o~...k~a~t .................................... ................. ~:.~..,..~; ~ ~.'.-.9.~. ....... ~.~.;.~.; ...................... to ...i~.a....~t~...9.a;~.....f.~.~,~;.. ~:~.~.~. ~ ................................................................ at premises ocated at . ~ai,t,a:t,,Jpdl,~ ~L~..~ ................................................... ............................................... ~S~Ut.J~o~L~ ..ti ~'.o ............................................................................... pursuan¢ to application dated .......................... ..~.*J~.~.~lo, ......... ~ ......... , 19..~.~..., and approved by the Building Inspector. Fee $.],,O,eJJO ........... Building 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 (GiVe deed ~cation~ have been inspected by this department and found to be satisfactory. ~istrict Engineer District Engineer bAVI lb J. pOUT~Okb TOWa oF' fouT~,.,t.~,~ ¥- FOI~M ~0. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ,19 ........ Permit No...~....~....°~ ....... ~.............~ Application No. ~ ~ c~ ~ ~ APPLICATION FOR BUILDING FERMIT ................... ............... , .... INSTRUCTIONS o. Th~s opphcat~on 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 adjmmng premises or public streets o, areas, and g,wng a detailed description of layout of propertymust be drawn on the d~ogram which is part of th~s application c. The work covered by this application may not be commenced before ~ssuonce of Building Permit. d Upon approval of th~s apphcat~on, the Building Inspector wdl issue a Building Permit to the applicant. Such permit shall be kept on the premises ovadable for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or ~n port 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 thc Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code an, d~egulations. (Signature of applL~j~nt, or game, if a corporation) ............ ............ ................. ....... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N a me of owner of pre m,ses ......~...../~....~...~.....~....~...~....'~....'~..~ ...'~.....~..~..../.. .......................................................................... orate, signature of du~orized officer. X 1. Location of land on wh,c~ l:~roposed work will be done. Maj~Ng ........ ~....~ ......... ;..' ................ Lot No: .~....~ ........... Street and Number ...... ~.~.(J~'h~r.~..~ ..... .~..SM~t.f~ ............................................................................. 2. State ex~sting use and occupancy of premises and ~ntended use and occupancy of proposed construction: a. Existing use and occupancy ................ ~ ........................................................................................................... b ,'c~z/-~/~'-~-~ "- Intended use and occupancy ............................................................................................................................. 3 Nature of work (check which applicable). New Building .................. Addition ................. Alteration .................. Repair .................... Rem~9.vol .................... Dernohtion .................... Other Work (Describe) ..................................... 4. Est~moted Cost ........... ..~..~.~.~.....'~ ................. Fee .......................................................................................... (to be paid on filing th~s application) 5. If dwelhng, number of dwelling units............................'e-m/ Number of dwelling units on each floor ............................ If garage, number of cars .................... .Z. ............. .~ ..................................................................................................... 6. If business, commercial or mixed occupancy, speofy nature and extent of each type of use ................................ 7 Dm~ensions of existing structures, if any: Front .......................... Rear .......................... Depth ............................ Height ............................ Number of Stories ............................................................................................................... D~mens~ons of same structure w~th alterations or additions' Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ........................................ 8. D,menslons of entire new construct,on' Front ........ ,:...~.pr...~. .......... Rear ....... ..'~/..~...~. ........... Depth ......-~...~...~. ............. Height .......... /~. ............. Number of Stones ......... .N ................ 9 S,ze of lot. Front ...,,/~.t~...'~."..~'.. .......... Rear ....... ./..~:...~. ...... Depth ...... ./....~..4.?...~.. .......... ,4 , ..4/..z.' 10 Date of Purchase ...... ......................... Name of Former Owner ...~....~.°....6...;...~.~...L..G..../~....~'..°..?'...Z...~.. ....... 11. Zone or use d~strict m wh,ch premises are s~tuated ................................................................................................. 12 Does proposed construction wolate any zoning law, ordinance or regulahon? ..................... ;: .............................. 13 Name of Owner of prem,ses ..-~...~.~..~.,....~.~.~?....~ress .~..~.z..~,?..-~..3....~...,~,Pho~neX~-o..~..:z.P...~..~..~.~::c. Name of Architect ......... -x ........... .,../.- ......................... Address ................... 4...--~.t ..... /. ....... Phone No....../. Name of Co ntracto r .~..'...~ ~.~.~ .,.~Cp.I .v..~. ::x/ ................. PLOT DIAGRAMAddress" ./..~../.~'../~...~_ ~~IH ;~n~one N o. zz_4.'.~., j..b?.?..?.. Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-bock dimensions from property hnes. G~ve street and block numbers or description according to deed, and show street names and indicate whether ~nterior or corner lot. ID.i' STATE OF NEW,'YORI~,z ~/z? / ¢ c couNw OF ..~~~_,.~ . ~ ..................... being duly sworn, deposes and says that he s the app cant ......... ~xx"t~'~s-r~'~iZ-~ndtvidual sign,rig ~lication) above named He is the ....... ff_~pr:~.r..~..-:~.~. ........................................................................................................................ (Contractor, agent, corp/~r~e off,r, etc.) of sa~d owner or owners, and is duly authorized to perform or have per~3z~¢ rye saifY'pfork and t.o~..rrrgke and file th~s apphcat~on; that all statements contained m this application are/frffi~ t~ th~ ~ his knowlbjl~r-~ belief; and that the work wdl be performed in the manner set,~fgrt-h-tn-'the~~ f4jcB/fhffrCo4v~ ~ ~' Sworn to before me th~s ~. /~ _ ~ d~v.~ '"'-.._ ff ) //~. , . ~ ..... ,.~'~ '~ C~_~¢.~ / ' "'x ~; / ~ ' //// Notary Pub,,c, .~.~..,,~£.-~./.~¢~.~.~-~.~[-m~...~~'/J' '~" ........ 'i~,gnoture~apl~':~'t~ ......................