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Home My WebLink About3525-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI-IOLD, N. Y. BERTIFIBATE r-'iF BP. 13UPANP. Y No.. ~;.2~6... Date ........... I~o.xrembe.lf.. 2.8..., 19..67 TI{IS CERTIFIES that the buildinE located at ~/$. C. lea~.v, ie~¢.. A~e ....... Street ~ap ¢,~:~hr.~'~'~'~ ~g,~ ~o ............. Lot No.'*,... S~'~'~*,~'~. :"...~. ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~lJle. ·..~).., 19.67. pursuant to which Building Permit No.. dated ........... ~tt~. 27 ·., 19.~7., 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 .Pri.v. ate. on~. £4~mf2~ .41~-~[.J~il~g ....................................... The certificate is issued to . .B~n~.amin..~. FJ~oa*.et~ce..Ifolztr~sk:~ ..... 0~ael's ......... (owner, lessee or tenant) of the a£oresaid building. Suffolk County Department of Health Approval .~io.V., .~+.~ .1.~6~...1~.~ .~,. FORM~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT .(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3525 Z D~te ..................... ~..:..~,. ........ :....., Permission is hereby granted to: ......... ~.~.~..~:-,..~: ~.~w~.e ...~.~ ... ...................... '....S~[t~oI~...~.~k:~ .................... ~o ~a.~..-~..i'~!~,.a~x~ ....................................................... ~ ............................ ~t premises l~ted ~t~i,.~.~..~i[]~i~i,.~.~...~ ..................... ~. .............................................. ......................... ~s..~~..~,~.: ........ ~ ............ ,.. ............................. ;.;.. ......... ; .... .............................................. ., ............................................................... ~ ......... ~ ................................. : ..... pursu~ to opp[ic~tion ~fed ............. ~ ........... ~.~ ....... ~ ..........~, ]~..~.~ ~nd ~pprov~ by the BuiJding Inspector. Fee ~Oe ............ Building Inspector./ S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da~e Bldg. Permit No. NOV 2'~ ~0~v TO WHOM IT MAY CONCERN: The sewage (Give deed 1 tion) disposal facilities for a structure located have been inspected by this department and found to be satisfactory. ~ _FORM HO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y.~ Application No ............................ APPLICATIOM FOR BUILDING' PERMIT Date ......~.....C~...J~...~.. ......... )..q. ....................... , 19.~.7 .... '- ~ INSTRU~IONS '~ ~ 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 port 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 appficant. 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 Building 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, ordirj~i~es, building code and _regulations. ! ,A*Sig ature of applicant, or name, if a corporation) /(Address of applicant) / .................... State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ................................................ Name of owner of premises .~....~...~:~..~/Z~.....-~..~..~......~...L.°.~..~..~/..~.....~.. ...... .~..°....~..'.'~"..~....~.J.~ ...................................... Jf 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. JV~ap No.: ........................................ Lot No.: ....~. .................. ..c..l ' ' Street and Number .e,,~.~l..~....~...../g..V...~.~.(J..~.,..7.~.~r~l.~..~..~'.L..~.... ~ ..... .~..~.~...~....~.....o. .. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....[V~..-.~-~..~.../-........./~....O- ./"'.. ...................................................................................... b. Intended useandoccupancy ..... e-~ -/,_.r.~...~,~...~..~.~,.......~..~....~...(.!¥.....~.....~....~...!_j.~.~.~.. ........................................... / 3. Nature of work (check Which applicable): New Building'....k~............. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ............. ;.... Other Work (Describe) ........................................ 4. Estimated Cost .....~..~.;.~.~...0. ....................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ l ................... Number of dwelling units on each floor ....... ~. ................... If garage, number of cars ..........~ ....................................................................... . 6. If business, commercial or mixed occupancy, specify nature and exten[ of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... .~./.../. ..................... Rear ...... .~'./....~.. ........... Depth ..s~..~. ............ Height .................... Number of Stories '/. ......................................................... 9. Size of lot: Front ..... ./.~ ........... Rear ....~...~'..~....3....~. .............. Depth ....~..~. ............... 10. Date of Purchase ...~...~..~..~.....~..r..L~.7. ................ Name .of Former Owner ..~.~..'.~..t..../~..~.'..~./..~..v. ~'o~, 11. Zone or use district in which premises ore situated .../~..~..~S.J..~..~./?..'~'../.~..~.. ......... "'7' ........ "~ ....... 12. Does proposed const~'uction violate any zen ng aw, ord nonce or regu at on> ~.' .................................................. Name of Owner of prem!ses~..¢,~.~.~.~..~.~..~,., koZI;.$.~(~dress ...~..~.~.t.~..q~.-. ~..~.~.~.'.~.'.~.~..: ~'Phone Nc~'~...~'..'T..~..e~.. 13. N~'t-,_PI,~'¢.~_'" 'I~_~ "' "/' .................. A mc h it ect ~:~z~.[ .s~. i. :,q.~. ,~.~, .~.),..~. ~ .~..:/J- --~, ,," ~J __ .............. Address ~..I.~.~.I.,'T..~...!f~.~.i,i.J_i,~, ............... ~, Phone No ..................... Name of C~~. ,9./J. ~J.~...~../~. ~,~;,/~,~:.~[,v_~/~'~ ~ '~'''''~ ......... Address ~...e',~/...//~). [~ ff.. ,~. ~ ~. ~ Name of 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 descr~otio~ qccording to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW' YORK, COUNTY O~ ........................ ................................................................................ ,.~ ............... being (Name of individual signing application) du~y sworn, depots oral says that he is the applicant above named. He is the ......................................................................................................................................................... ~:. ~ ~ (Contra~t,or, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to per~o;rn~ or hbye :'~)e~'fo~'r~b the said work and to ~ke and file ~?s applica?on~.,t~at al~ state~ contoi~ i~ t~i~. ~p~icati~are t~e,{~ the best of his knowledge and belief; and mat the WOrK Wm De permrm~U~[n,the m~ner ~t f6~ in~e a~c~tJ~.'~ed therewith. Swom to ~fore me this ~ ~ , / ~ ~ ..... of ...................... , - /Z - . ,_ ............................ Nota~ Publi~.~....~.¢.~ ...... Coun~ // (Si~ nature of applicant) ....