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Home My WebLink About3621-zTOWI~ OF SOUTHOLD BUILD~N~ DEPAi~TMENT TOWN CLEHK'S OFFICE SOUTHOLD, N. Y. ~o. Z3099 ...... Date ................ ~.ll..vle ..... ~ .... , 19.68. THIS CERTIFIES that the building located at . ~/fi]...~I~3.~.. ~l~o~k· ~)~.~O- - Street Map No.. ;1~ ........ Block No..:l~; ........ Lot NoZtZg...~t~ll~;hold .. II~Y.. ............ conforms substantially to the Applicafi, on for Building Permit heretofore filed in this office dated ........... ~ep~...]~ ..... 19.~. pursuant to which Building Permit lXlo.~l~.q[..~.. dated ............ ~e.pt .... ~1.~., 19~., was issued, and conforms to all of the require- ments .6'f' the applicable provisions of the law. The .o.ccupancy for which this certificate is issued is ... Pr. iva~;e. ~r~.£a~it.y. d~eLl, ing ........................................ The certificate is issued t,o .~ObOX~;. A~d ....... ~ ............................... (owner, lessee or tenant) of the aforesaid building, .Suffolk County Department of Health ApprovalDe~., .1~.~.. ~9(~...b~ ,R~..Vi.~.~a. ........ Building Inspector FOIJl~ NO. ~ TOWN OF $OUTHOLD BUILDING DEI~-ARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N~ Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON,THE PREMISES COMPLETION OF THE VORK AUTHORIZED) N? ,3621 Z Permission is hereby granted to: , UNTIL FULL pursuan¢ to application dated ....... ~.~.t,....~jJ. ., 19...~., and approved by the Building Inspector. Building -!nspect0r- ~, ~ $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date I-~-" I q Bldg. Permit No. 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. District Engineer FOI~M NO. 1 Examined .................................... , 19. .. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No .......... Applicatio~ Ho ............... ~ ............. D~sapproved a/c ~: ............. ................................ ........................... APPLICATION FOI~ BUILDING I~EI~,MIT Dote .......................... 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 propertymust be drawn an 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 witl 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, ordin~t~ces, building code and regulations.//' . , ........... · {S'gnmure ~ app icon, or name, Jfa corporation) (Address of applicant)// u State whether appJicant~is(~..Q°w~ner'~.Jessee' agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~.~.....'.~....~...~.....~....'.~.....~....~.....~.....~/~. .................................................... if applicant is a 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: ............................................Lot No: .................... Street and Number ........ /~..../.'../.....~.........~..."..~.....~.~..~l~./..,~,~.......:.....~...~..~...~ .................................................................. Municipality 2. State existing use and occupancy of pren~ses and intended use and occupancy of proposed construction: n . //L>9 c. iv .......... a. Existing use a d occupa cy ......... ~.....~..~ ............ :; ...................................................................................... b. Intended use and occupancy ....... . .~{{i....c~..'i...t~....<. ~. · .~...'.~......{~.~....-~..~ .................................................................... Repj~ir ................... .~emovol .................... Demolition .................... Other Work (Describe) 4. Esti,~ated Cost ,.....'~.~.....~...~.....~.,..~.. .................... ......Fee .............. ./...~...,..~..... I (to be paid on filing this application) 5. If d,We lng, number of dwelling units ............... ./. ........... Number of dwelling units on each floor If glbrage, number of cars ........................... 6. If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dirr~nsions of existing structures, if any: Front .......................... Rear .......................... Depth Hal!iht ............................ Number of Stories Din'~nsions of same structure with alterations or additions: Front ................................ Rear Dep'h .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front .......... .,~.....~.. ......... Rear ........ ..,~.,~. ........... Depth Hek, ht ....... ./.~... ............. Number of Stories ....... /.. .................. 9. Size of lot: Front ,...~../'...'~...~..... Rear ~../'...~..~..... Depth ...J'....~..~.'T..../..~....~,.. 10. Dat~ of Purchase .......... .......................... Name of Former Owner ..... /~.~...~r~,.~.~,...~....'../~...~....~...~.. 11. Zon, or use district in which premises ore situated 12. Doe proposed construction violate any zoning law, ordinance or regulation? 13. NarCo of Owner of premises ........................................ Address ............................................ Phone No. Na~ ~e of Architect ...................................................... Address ............................................ Phone No. Nat of Contractor .................................................... Address ............................................ Phone No. : PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr, ~es. Give street and block numbers or description according to deed, and show street names and · erior ar corner lot. L.ocat property Jj whether in COUNTY ................................ ................................................................................................ being duly sworn, deposes and says that he is the qame of individual signing application) above nar ed. He is the (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and f this appJJc ~tion; that all statements contained in this application are true to the best of his knowledge and beli, and that t'le work will be performed in the manner set forth in the application filed therewith. Sworn to I:~fore me this / fl ~ n , J' · , '~ . ,~ ......... ........ Notary Pul .lic, ..~.~...b~~~¢nbN0. ~ '~~'~:¢~-t'~;";~";~l~iic~'~i ........................