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Home My WebLink About3527-zFOl~i~l l'qO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWI~ CLEEK'S OFFICE SOUTHOLD. N. Y. OEI~TIF'IOATE OF' DOOUPANO¥ No..~. 3.432... Date .......... Ma:CCh... 11!1o ......... 19.69, THIS CERTIFIES that the building located at .Bay. Haven. Lane ........... Street Map No. ~.~10 ....... Block No ............. Lot No. 43.,.. Slalatllold,. bi, Y, ............ conforms substantially $o the Applicatinn for Building Permit heretoioTe filed in this office dated ...... ~tlrte...2?, ........ 19.67. pu.rsuant to which Building Permit No. 3,52.7..7~, dated ...... J. tllaa .. 2.7., ....... , 19. ~7., was issued, and conforms to all of the require- men~;s .of the applicable provisions of the law. Tbe .occupancy f. or which this certificate is issued is ..... p.:r i.v. at~a .one. family..~lwell£ng ..................... '. ................ The certificate is issued t~o ....Wil.l. iam.~}V.ells ....................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval F. eba:laa~y. 27 ,..19~9,. Robe:ri..Vt3,1a ........... fiilhi; ' ........... FORM NO..2 TOWN OF soUT9OL~ BUILDING rDEpARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER~IT ~HIS PERMIT MUST BE KEPT ON THE PREMISES UN'riL FULL' COMPLETION OF THE WORK AUTHORIZED) N? 3527. Z Permission is hereby grenteiJ to: to ~.~,~,~..~-,,~ .. ~,,.~...,,,,,~,.~,...-..,~,,,,.~ ....................................... ~ ............................ ~. .............. Building Inspector. , ' '" '' '.'' S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM at IT MAY CONCERN: The sewage disposal/fTilities for ~ (Giv_e>ed location) a structure located have been inspected by this department and found to be satisfactory. District Engineer ~ FO~M NO. I TOWN OF SOUTHOLD ~ ~UL~DING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y~ Examined ..................... 19 ..... /~ppraveo ........................................ ly ........ I-'ermit No .............................. (Building IntJpector) / .... ~. :.L..: · APPLICATION FOR BUILDING PL~MIT · ~ -., V ., . ~i± ., INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicafe 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 part of this location. 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 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 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, leSSee, agent, architect, engineer, general contractor, electrician, plumber or builder. Juil~ex. Name of owner of premises ....... .~...l..1...~.~...~.e...~..~..J.. .............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ~_L 0 .C' ~. 1. Location of land on which proposed work will be done. Mop No: ............... .J..t~.. ................... ~ No: ..... ~ .......... Nh mber .J....l~. ~ven ~.e.~ ~.o.~t~.e..1.~. . '-'- ~ ~- Street and ............................. ;~ ................................................................................................... ~'/~ ~, ~'~ Municipality 2. State existing use and occupancy of premises and intended use a~'d o~:~c~upr~ncy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy ............ ?..?...l...v..~...~..e.,...~.?.e.~.l..$...i~. ......................................................................... ,,. 3. Nature of work (check which applicable): New Building ...... .~ ........... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ...... ~1,~.~,.~ ............................ ;...Fee ..,.l~.{~J~. . ............. (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 extent 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 ................................ ~. Dimensions of entire new construction: Front ....... Height ~.~t Number of Stories '! Size of lot: Front ...... ]-~J. .............. Rear ......... '1~ ............ Depth ........ 3,~& ............ Date of Purchase ....,..~...e.~..~..?.,...~...~..~ ...................... Name of Former Owner ....... .~...~..]....~.~...~e..]...~..~ ................. Zone or use district in which premises are situated ... ~.~..~..~l.~.~l...a...~. ..................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~.~. .................................. 13. Name of Owner of premises.~...~t,~l. ................. Address ....... ~lt~r...~l'~l~ .............. Phone NO.?~I~.~4,~.. Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .............lJ..~l~l .............................. Address ............................................ Phone NO ..................... 10. '11. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot; STATE OF NEW YORK, ) S S. COUN19L'_. OF .... ~l~'~{j,3,,~ ....... ) 0.[ .......................... ~.~;[~l~..~ljl. ............................. ;.>$.e..;;b~g duJ~sworn, d~es and says that he is the appl~ant (Name of individual signing applicati~) ~ ....... ' ' ' ' a~ve named. He is the ................ ,..~.~.~. ........................................................................................................................ (Contractor, agent, corporate officer, etC.) of said owner or owne~, and is duly authorized to ~rform or have pefform~ the ~id work and to make and file this application; that all statements contained in this application are true to the ~ of his ~l~ge and belief; and that the work will be performed in the f thi Sworn to be ore me s ........... ~.~.Ya... da~ of ....~.~ .................... ;~~ ~ ~ [SJgnatqre of applicant) .................