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Home My WebLink About3584-zFORM I~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. n£RTIFIr. AT£ OF OGP. LIPANnY THIS CERTIFIES that the building located at . .I~.~.B....~.~...l~..a..d ........... Street Map No....~.. ....... Block No....~. ........ Lot No ..... ~ ..... .~q..~..~.~.O.~..~. .... ~:.~.:... conforms substantially to the Applicati,on for Building Permit heretof,qre fried in this office dated .............. &llg .... 2~, 19.6.~. pursuant to which Building Permit No. dated ............ ~...~. .... 19.~7., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The occupancy f,cr which this certificate is issued is ... ~.l~.~at~. OD, e. ~.a~.].)'. ~hre,~..~ n~ ........................................ The certificate is issued to . .~eS..~1'0J~$ ............... 0Rn~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... Jail,...2~... 1.'~..b.yR,..~.;l.l&... FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N? (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 358zt Z ~te ............ i ............ ,~.~..~.....~......, ~..~7':~' Permission is hereby granted ,to: .................. .~.~.~....'..~ ................... ....~: ........ · . .. O~t~o~.e..~ ~,:~.,. . , ........................................................................................... 7' ...... Y~'"'"':7'~ ......... ~' "' "'"'"'y" pursua:n~ .to application dated .......... :...' ............... ~1~.~ ...... .~.~. ........... , 19.~,~., o~Cl c~pptOVed by the Building Inspector.. Building Inspector $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH J~N 24 ~88' Da~e, Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities (Oiv/e deed koc~ion) for a structure located have been inspected by this department and found to be satisfactory. District Engineer FOI~M NO. 1 ·OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ........ Approved ................ .I;..t,. .................... , 19...e.?... Permit No....................,....... ~-'~ (Building ~pector) APPLICATION FOR BUILDING PERMIT Date ...~.~.,~,.~....~,,.,.,; .............................. , 19..~...7.... 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 anal regulations. (Signature of applicant, or name, if a corporation) (~ddress of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ~'.~.~...~.....]4~... Lot No.: ........................ Street and Number ....~c~?..-~.. ..... ~....". ....... ' ~...~..~.. ' ........................................ ~ Muni~pali~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~............~..~ ................................................................. ~ ..................................... .............. b. Intended 3. Nature of work (check which applicable): New Building .... .~. ........ Addition .................. Altera¢ion Rel~air .................. Removal .................. Demolition .................. Other Work (Describe) 4. Estimated Cost ........~..~,~..~ ....... i ..................... Fee ........... /....~....~......~... ........................................................ i (to be paid on filing this application) 5. If ~Jwelling, number of dwelling units ............ /. .............. Number of dwelling units on each floor If ~arage, number of cars ...................................................................................................................................... 6. If ~usiness, commercial or mixed occupancy, ~pecify nature and extent of each type of use 7. Dimensions of existing structures, Jf any: Front ............................ Rear ................................ Depth Heilght Number of Star es ............................................................................. Dir~ensions of same structure with alterations or additions: Front ....................................Rear Del~th ................................ Height ............................ Number of Stories ...... 8. Dir~ensions of entire new construction: Front ...... (~..~......~.. ............. Rear..../~'_~..... 1 He~,ght ....... j...~.. ..... Number of Stories ......... ~ ................................................................... 9. Siz~ of lot: Front .......6."..C¢C~.....t. ..... Rear ..]....~ .............. Depth ...._~....:~..~.~......~.,~9 Do~e of Purchase ...... /...~...(~...J~. ............................... Name of Farrier O,~ner ~...~ .... 10. Zone or use district in which premises are situated ../.(~....~m...~...Z ......................... 11. 12. Does proposed construction ¥iolate any zoning law, ordinance o~e, gu.~lation? ..... ~.....-,~ g ..................................... 13. Na~ ~e of Owner of prerg!ses/~.~-~k~...~...Address ..~.~., .~.~..JT....F.~. Phone No. Nar ~e of Architect ~..IJ~~..~~.~.~..~.. Phone No. Nar~e of Contractor...~,~...~]~,.~.~: ...... Zddress ...~.~.;..~...~.... Phone PLOT DIAGRAM I_ocat[e clearly and distinctly all buildings, whether existing or proposed and indicate all set-back dimensions property lines. Give street and block number or description according to deed, and show street names and whether in}erior or corner lot. I ~ ,SS COUNTY~ ~)F ....................... ~-.:....f ' ' ..q~.~ .......................... being duly sworn deposes end says that he is the applic Nome of individual signing opplicetion) above nor ed. He is the (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 application; that ail statements contained in this application are true to the best of his knowledge and belief; that the w~rk will be performed in the manner set forth in the filed therewith. Sworn to b~re me this · ..... ...... , , ~0. 52-3233120 Suffolk ~rm ~pire~ ~arch 30,