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Home My WebLink About3564-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. EI~TIFIP. ATE I-IF OP.P. UPANP. Y No. ~!~7 ...... Date .............. ]l~ll~l'. ~, 19.67 THIS CERTIFIES that the building located at IdlaO. ~ ................ Street ~o.8~ Map ...... l~a!'!l~lock No ............. Lot No. l~ .J.O~...IJtlt, eho~te. I[,~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ &ll~ ....~ ..... , 19 67. pursuant to which Building Permit No. ~,~t~S. dated ....... &l~ .....9 ...... ,19..6~, 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 . .l~i,a~e. ot~e-l'ea~J.t~:-~'~e.l-~mg ...................................... The certificate is issued to . ~[Olall. & -R,a~.~l'lee. G®S~le ........ 0vlael,~ ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .}~ov,..29,..~9~- .................. Building Inspect]~r FOEWt NO~ ~ 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)' NV 356 Z Permission is'hereby granted to: th ~ild ~e~' one f~iy dweJ~l~g .... at pre, raises located at ~0..~..~.'...~...0.5.....~0~.~..~....~!,~;!~).~ ...................... : .............................................. pursua:n¢ to app[iqatior~ doted ............................... .~..~.~,. ......... ~.. ......... , 19..~.~...., and approved by the Building Inspector. " Fee $ ........~...; .......... 'Building Inspector, SCHD SUFFOLK COUNTY DEPARTMENT OF ~EALTH Bldg. Permit No. T ~ ~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. P~o~' m 0 ¥ d OHN ~. MAP OF LAkJD ~dt~.v ~ YE~ D EAST CUTC N~W Y'O~.K Premises shown m-¢ ~rt S ..ALE'. ' ' ' ~ Au~d5~' 5~ 1967 VAN TL.;YL ~SON b[cm'~sc:d L.~n~ G t"ea~ ~o r~'. New Vor k ~OKM NO. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................... ..~........~ ........ , Approved ........................................ , 19 ........ Permit No ..... "· .................. Disapproved a/c ................................ ~ .................. Application No....~..~:~..(.( .......... INSTRUCTIONS 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 part 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 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ......... L. (Signatur&of applicant, or name, if a c~¥~ration) ...... (Address of applic&nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises . .~.~. .......... f~:..%. ..................................................................... If applicant is a~corporate, signature of duly authorized officer. ........... ....~, ,~,,,~.....(~. ~,~;..~.!.~..~........~.~...~?. ,~. ........................... ~(~lame and title of corporate officer) t¥l/-~Lj~ ~ ~S,~'lu F~J P-J'~ 1. Location of land on which proposed work will be done. Map No.: ........................ Lot No.: Street and Number ........ L.i.L fJs ...... ........................ ..... ........ .............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy . .. .~. ~ ...... I i~ .~ .gd ~ .~..~..(. ................................. 4. 5. 6, Nature of work (check which applicable): New Building .................. Addition .................. Alteration Rel:3ir .................. Removal .................. Demolition .................. Other Work (Describe) Esti noted Cost ....2.+.o..?..o..~ .......................................... Fee _,/..0. , (to be paid on filing this application) If 'welling, number of dwelling units ....... I .................... Number of dwelling units on each floor ...~....~...'~...~. If g?oge, number of cars If business, commercial or mixed occupancy, specify nature and extent of each type of use Di?ensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Rear Del~th ................................ Height ............................ Number of Stories ................................ Dimensions of entire new constr6ction: Front .....qf..).f ......................... Rear ......L(.).L ............... Depth Height ...... ...... Number of Stories ....... .~..r%c..~x.....rr..~.,:.t.~.,.S.r;.?..~ ...... .......... Siz~ of lot: Front ..J.~.~..'..~;./r ............ Rear ..... (,.~.:..2.~ .................. Depth ..'~..~..l.,.~..~..~.....~=.%...I, Dat~ of Purchase ..... .~..~..c..:...~..~..f.~ ............................. Name of Former Owner ...~.~,..~..~,.~....~..,.....~'..t~..~.~.L.~.~.x,~.... Zorje or use district in which premises are situated ................................................ Doe's~ proposed construction violate any zoning law, ordinance or regulation? ........ t.'..,? .............. i ' d~ ~ . ~t ~ ~ t,Z~4' '\~'" ' , Na~neof Owner of premises ............ Phone No. Na~e of Architect .......................................... ,~, .......... Address ......................................... .,*Phone No. Na,~e of Contractor ,..L.~,,~D,,~,,e,3.I... ~..'2~...%~ .¥.~.Address..'. :.1. Z.~....~...~. .?.~.. n PLOT DIAGRAM ,~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions nes. Give street and block number or description according to deed, and show street names and indic :erior or corner lot. 10. 11. 12. 13. Locat property whether in STATE OFJ NEW~..Y, ORI~. /~. ~ S S COUNTY IOF .~.:~.ff[.,(.~-...~.~f ' ' I(Name.6f individual signina application) abow, nad ,e~V~e is the ............. (~.,~,~.:....::::.~;;... " t duly sworn, deposes and says that he is the applk (Contractor, agent, corporate officer, etc.) of said o~,ner or owners, and is duly authorized to perform or have performed the said work and to make and this oppli,:ation; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ erk will be performed in the manner set forth in the application filed therewith. Sworn to t efore me this ................bi'""~" aay o'r ................. .~., :: .......~ ............ 19..~..~.....i. Notary Purlic ~-..... ,. .... ........ County ~, (Signature applicant) Term Expires March 3,~ ~