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Home My WebLink About3387-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIE:ATE OF OBIgUPANBY No. It; 281~!- Date .AUgUSt; 23, 19 THIS CERTIFIES that the building located at 8/S ~Toekey C~'eek I)l' Street Map No. ~m. Block No xXX Lot No. X~ - SO%ti;hold,. N,Y, ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated 14a%,ch · ~. , 19 67 pursuant to which Building Permit No. 3.387 Z dated Mai'ch' 3 , 19 67' 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 Private one. -family' clwetlir~g ................................. The certihcate is issued to John ~T....0 !Kae~.e ....... Ow~el~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Allg. 16,. 196~...by R, FORM NO. Z 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? 3387 Z Permission is hereby granted to: ............... ~..*.~.*.~ ........................................... ~ ..... Zzm~ oz~ £a~11¥ dwelling pursuan¢ to application dated [u"a'Z~h [ 19 6~ , and approved by the Building Inspector. Fee $.,.~..0..?.~ .......... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH ~ 1~ ~67 Da~e Bldg. Permit No. TO WHOM IT HAY CONCERN: The sewage disposal faciliti~ for a structure located f f (tire de~d ~oc~t~on) have been inspected by this department and found to be satisfactory. District Engineer District Engineer FOI~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................ APPLICATION FOR BUILDING PERMIT Date .................. ,?..//..../.~...~ ........................... ,19 ............ INSTRUCTIONS a. This applicohon 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 gwmg a detaded description of layout of propertymust be drawn on the d~agram 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 th~s 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 m part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Buddmg Inspector. APPLICATION iS HEREBY MADE to the Building Deportment for the issuance of o Building Permit pursuant to the Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcoble Laws, Ordinances or Regulahons, for the censtruct~on of buddings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all applicable lows, ordinances, building code and reg~ul~qtions. (Signature f~l applicant, or name, if a cf)rporat~on) ............. .......... .............. (.j (Address of applicant) If applicant ~s a corpora e, signa e o duly cYutho 'z 'c . (Name and t~tle of corporate officer) 1. Location of land on which proposecJ work will be done,~ Map N9 ............................... ,( ....... ~.. Lot No: .................... Street and Number ............ U ~'~ Mumcipality 2. State existing use and occupancy of prem,ses and intended use ~ag~J occupancy of proposed construction: a. ~l~i~'g use and occupancy .................................. ...~..~'~"~~-- ' /~J~" '-- .................................................................. b. Intended use and occupancy ............................................................................................................................... 3. Nature of work (check which apphcable): New Budding ..... ~ ...... Addition .................. Alteration ................. Repair .................... Removal .................... Demoht~on .................... Other Work (Describe) .................................... 4, Estimated Cost ............. ~.c2.~.¢rtc2i2. ................................ Fee ......................................................................................... (to be pa~d on filing this application) 5. If dwelhng, number of dwelling umts ................... .?.. ..... Number of dwelling units on each floor ..... ~. .................. If garage, number of cars ........................... ~ ........................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................... 7 D~mensions 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~mens~ons of enbre new construcbon: Front ............. ..8'..~'. ......... Rear ............. 0~...¢....~ ...... Depth ....... ~Z~...~ ......... Height .............. ~.~ .......Number of Stories ............Z.~ ......... ~ O 9 S~ze of lot Front ............. ~.~ .......... Rear ...... ~A~ ........... Depth .......... &.~. ............. 10. Date of Purchase ...........~.~A ........ ~.~ ..................... Name of Former ~ner ....................................................... 11 Zone or use d~strict in which premises are s;tuated ................................................................................................ 12 Does proposed construction violate any zomng law, ordinance or regulation? ............ .~ ................................... Ol te , ................... of ...... .......... .............. Nome of Architect ...................................................... Address ............................................ Phone No .................... Name of Contractor 3eo ~/e'~ --d'res ~ ~ ~? ~ //Phone No. .................................................. ~ a s. ~.~.K~ ~ ~ PLOT DIAG~M Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and mndicate all set-back dimensmons fron property hnes. Grove street and block numbers or description according to deed, and show street names and indicat, whether mnterior or corner lot. ~ 3 ( STATE OF NEW YORK, couN ........................... ........ .,,,,~...~.~ ........... ~.~ ..................................... being duly sworn,,, deposes and says that he is the applicant (NamCJof individual s~gmng apphcation) above named. He ~s 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 fil~ th~s apphcahon, that oll statements contained in th~s application are true to the best of his knowledge and belief and that the work wdl be performed in the manner set forth in the apphcation filed therewith. ' Sworn to befgre me th~s ........... .... day of ............. , 19.. ,~..~ ~I~ , Notary Pub'.c, ...~a ..... ..~ ..... .~¢~.-~:/~ o u, rkty i ~'. _, '""~/~igna~e of applicant) Term Expires