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Home My WebLink About3589-zFOEM I~0. 4 TOWN OF SOUTHOLD RUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. No..~0~.~ .... Date ............. ~:'a~ · · ~9 .......... 19..~8 THIS CERTIFIES that the building located at . ]{/$...~/aveflR$at. Lalaa .... Street Map No..8.~.~..~..&~..1~ l~k No ............. Lot No. :[6 .... ~tti.tl~$1z~. ~Y. ........ conforms substantially to the Applicati,on for Building Permit heretofore filed in this office dated ........ ~,11~ ....28 ...... , 19.6t pursuant to which Building Permit No.~8~... dated .......... lll~... 28 .... , 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 . .. P~.V&te..Or~. faln~1.~, d~e~[,],tl~[ ........................................ The certificate is issued to . (la~bOl'. ~[~e ........... 0~r/lex, ........................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ..... ](1~ .... ~[~... 1~8...by..R~..~'~,.'l.~.&. FORM NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLET ON OF THE WORK AUTHORIZED) N? 3589 Z Pe~mission is hereby granted to:' at premises located at~ ....~.~.~.....~. ....... ..~.~.~...~:.¥...~.~.~.~,:¢.~.~ ....................................................... ................................... ~e..~.~,t,..~ue ........... ~,~ ...................................................... purspan¢ to .application dated ....~ .................... .~l~q.~. .......~ ....... , 19...~.~.., and approved by the Building Inspector. Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at (Give deed location) ..... have been inspected by this department and found to be satisfactory. Di~triot Distrtc~ Eugiue~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLER~('S OFFICE SOUTHOLD, N. Y. Approved ~'~ 19...~..~... Permit 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 issuence 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 fir 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. ........ ..... (Signature of applicant, or name, if o corporation) ......... ........ ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................... ............................................................................................................................ Name of owner of premises ............ ..~..~...~...~...O....~ ....... ~....~....C....,. ....................................................................................... If applicant is a co~orate, signatu~,e),,of duly authorized officer. ..................... L,z ....... ~ c~'~orporate officer) 1. Location of land on which proposed work will be done. Map No.: ..~..(~:..J~-.~.l.~.~ ~ot No.: ..... /. '~ ............ Street and Number ........ j~..~...g..c~.~....~.~..',~...'..~... ...... ,g..~/~.t.g...~. .................. .~)..~..,~r4~..~.~.....~.....~.. ............................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ~j./~ .~..~.. ~...: .-I~.. ....... ~../~...~.../~2 ................................................................... L b. Intended use and occupancy ......... ..1~.....~....~. ......... .j~'../~..~i...l.....~ ........ .~.....~.....~..~..(~,.....j.J~4..~.. ....................... 3. Natbre of work (check which applicable): New Building ....~[~.... Addition .................. Alteration Rel::ir .................. Removal .................. Demolition .................. Other Work (Describe) 4. Esti noted Cost ......... ~.~.j..(~.O .................. :. ........... Fee ........... /..1~.,./,.~.~. (to be paid on filing this application) 5. If welling, number of dwelling units ...... ~..l',J..~. ......... Number of dwelling units on each floor If g~arage, number of cars ............ ~..kl...~. 6. If I~usiness commercial or mixed occupancy, specify nature and extent of each type of use 7. Di~..ensions of ~ structures, if any: Front ............................ Rear ................................ Depth Heir, hr ........................ Number of Stories Di~ensionsr of same structure with alterations or additions: Front ............. ..~.~..,/. ........... Rear ...... ..~ De~Jth~l .../..~.......~....,~..1' ........ ' Height ........ j.../~ .............. ' Number of Stories .....O..~...~ ............. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth Height .................... Number of Stories Siz~ of lot'. Front .......... J.:~::~[ ....... Rear ......... .'~..~JJ,~.~ ......... Depth ...... .",J,,.'~,..~...~ ........ Datb of Purchase .............. t.~..(~..~ .............................. Nome of Former Owner ........ (...~,e'j..~..~.¢~.....l..~.C.., .... ZorJe or use district in which premises are situated ................i~./~...~'. ................................................ J Doe,s proposed construction violate any zoning law, ordinance or regulation? .............. z,,I...(.,~ .............................. Name| of Owner of premises ....... (..](~.~.~-~¢~./'~....,.~(...Address ..... ,~..JC:..~..~...~..~.½..¢..J~. ..... Phone No. Na e of Architect ...................................................... Address ............................................ Phone No. No~e of Controctor ..~..~.~,'~.~.l.~.,~.t0.~.t~. .............. Address ...~,,~.O.&..~.~ .................. Phone No.' PLOT DIAGRAM Locat, · 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. property I whether in (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 opplic~ation; that all statements contained in this ?pplicalion are true to the best of his knowledge and belief; that the wbrk will be performed in the manner set forth m the application filed therewith. Swo~ to I:{ef~re me this _ .~ 19~.'"7 day of ............. , ..... /J . , .... 7 ...... kJ ~OTARY pUBLIC, ~tate ~o. 52-3233120 Su~ol~ Term Expl es IVLa ch STATE OI NEW YORK, ~ c c COUNTY OF ................................ [~'~' ................................................................................................. being i(Name of individual signing application) abow; norfied. He is the duly sworn, deposes and says that he is the appJic