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Home My WebLink About3582-zFORM NO. 4- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CEI~TIFII3ATE OF OI313UPANI~.Y No. I~. 29}+9 ..... Date ............ l~ovembe~. '29 ', 196~' · THIS CERTIFIES that the building located at I~]g. t~illo. l~ock~ ltm.d ...... Street Map No...xX ..... Block No... XX ....... Lot No.~ X.X ' ' ' ~toxx~clao~:di· lq¥~:; ......... conforms substantially to the Applieation for Building Permit heretofore filed in this office dated ......... &~g... ~. , 1967. cursuant tO which Building Permit No. dated .......... Atlg ....2lq,..., 196,~" was iss~4ed, 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~l~:[v~e one' fa~i~y' 'gwe~'l:i:n§ ...................................... The certificate is issued to "(I i~a'y '~mTtlt''' 0,~1~;;,' i;~s'e;' ;;'t'e'~l~t')i ........ of the aforesaid building. Suffolk County Department of Health Approval .... '- ',... ~.X~.~ ....... Building Inspector ~ FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3582 Z Permission is hereby granted to: ................ ~,~m~o.3,~ ............................................. pursuan4' to application'dated .: .......... ' ................. ~3~j~t~....~. ...... ; 19.~.~..~ and approved by the Build!ng 'Inspector, Bu Jding Inspect6r /' S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da.ce Bldg. Permit TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. District Engineer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ...................... "J '.k. ................ , 19...~.~.... Permit No~) ,~<'~C~',~ ~ Application N .......................... APPLICATION FOR BUILDING PERMIT 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 drown on the diagram which is pa.rt of this application. c. The work covered by this application may not be commenced before issua.nce 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 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 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 ali (]pplicable Jaws, ordinances, building code on~ regulotio?. ................. (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. Name of owner of premises ...... .~.~:........~../.."......~...~.~<.~ ....................................................................................... ................... ~ ...... r "" '~"/" d. 7d.M~etTI. ....... .~Z--M~...;.. (Name and title of corporate officer) t. Location of land on which proposed work will be done. Map No.: ................. ~ ..........,.).. Lot No.: ........................ Street and Number ............................ ~...~.~. ............... Mumclpahty 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 .............................................................................................. 4. 5. 6. Nature of work (check which applicable): New Buildibg .................. Addition .................. Alteration .............. Rep6ir .................. Removal .................. Demolition....: ............. Other Work (Describe) .................................... J (to be paid on filing this application) If dlwelling, number of dwelling units ..... ~ ......... Number of dwelling units on each floor ........................ If garage, number of cars If [Jusiness, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 'ensions of existing structures, Jf any: Front .m. ................. =:... Rear ................................ Depth ................... ht ........................ Number of Stories ............................................................................................................. ensions of same structure with a.lteratJons or additions'. Front .................................... Rear ....................... th ................................ Height ............................ Number of Stories ................................ ensions of entire new construction: Front ....,,,~'..~ ....................... Rear ..,-~..."¢. .................. Depth ....~.... .......... iht ./..~...t. ......... Number of Stories ..... C~.,E~,¢~ .............................................................................................. of Purchase ........................................................ Name of Former Owner ...~.~ ............................... ZonJe or use district in which premises are situated ....~...~'....~. .............................................................................. Doe; proposed construction violate any ~oning law, ordinance or regulatioo? ..'~. ............................................... Nar ~e of Owner of premises C~...~.~......~. ......... Address ~/.. .................. Phone No ................. Nar ~e of Architect ................... : .......... ,~ ..................... Address ...... , .............. ~, ....... , ............. Phone No ................. PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr, nes. Give street and block number or description according to deed, and show street names and indic. erior or corner lot. 7. Din Hei Dirt 8. Din Hei 9. Siz( 10. Dar 11. 12. 13. /.ocat property I whether in STATEOFINEW YORK /-~ '""~-fJl ZL L,,( ' COUNTY DF .............................~,~'~' ~ .. t .,&,-_ ................. ~.....~{~CX ........................ being duly sworn, depos~ and sa that he is the applic( obove no~ed. Ho is the ..................cr:.~.~w~.~.~ ............................................................................................. : (Contractor, agent, corporate officer, etc.) of said 'her or owners, and is duly authorized to perform or have performed the said work and to m~ke and this applic ~tion; that all statements conta,ined in this application are true to the best of his knowledge and belief; that the ,rk will be performed in the manner set forth in the application filed therewith. Sworn to ffore me this Notary Pul~[ic, PUBLIC, ~lalc o~ New C No. 52-0618100 Su(folk Ooul 0mm~ssio. [:xplr~s i~larcl~ ~0, (Signature of applicant)