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Home My WebLink About3652-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P. ERTIFI~.ATE OF OP.P. UPANCY No.. Z. ~ .... Date ............ ~eee~be~-...8..., 19.67. THIS CERTIFIES that the building located at . ~.~t8 '¥e~;ls' t~'o ........... Street Map No.. ~ ..... Block No ..... 3[XX .... Lot No... ~ .... ~Otti;held~f -I~,-Y-, .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ .Atlg ..... ~... , 19.67 pursuant to which Building Permit No.. ~2. - dated ........ Att~..2~ ......... , 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 . Private. one. family, dweil!n[[ ...................................... The certificate is issued to .. [~orf~ .Ak[Mlitl. ' .... (h~eF. ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval'..De~.,. ~t..1~... ~'...R~..V.~[]~[~ .... Note~ As approved by Board of Appeals ..... Building Inspector Z~OP~'~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN cLERK's OFFICE SOUTHOLD, N, Y. - BUILDING PERMIT CrHIS PERMIT MOST BE Ki~PT ON THE PREMISES UNTIL FULL COMPLETION 'OF ,THE WOR'K AUTHORIZED)- N? 3652~ Z PermisSion is hereby gm0ted to: .,..?...,.~t~ ....... :..,...,......:~ .......... , ............. at Premises located at .,~../.~ ,.J?~.**~.,~.,&.~. ........... ................................................................ ; ............... ............, ..................... I~uJ~l~l~....,ll,~ ,..../ ........................................................... ~.. pursuq~,t.to application doted ~ .............. . ....... , ......... ~t~I~..~.~JJL.~MI~J~JlIJ~..~'~, and approved by the ~:ee *..;i,0~.~...' ....... 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 (Giv6 have been inspected by this department and found to be satisfactory. District F~gineer - District Engineer ~-;:--/ TOWN OF SOUTHOLD PROPERTY RECORD ~'" :/-~0,~ ' 7~ ~-I? suB. LOT oWNER TREET' -~ ~/'~'~ VIL~GE ~' FORMER. OWNER TYPE OF BUILDING 'LAND' IMP. AGE NEW NORMAL FARM Acre Tillable Woodland Meadowland -TOTAL. FARM DATE BUILDING CONDITION BELOW ABOVE Value Per Value Acre COMM. CB. MfCS. REMARKS FRONTAGE ON WATER FRONTAGE ON ROAD DEPTH , . Mkt. Value House Plot To,~o ~,=~ ~ BULKHEAD DOCK ,/ COLOR TRIM -:xtension '[xtension ~xtension t ~orch I reezeway ;oroge 'aria 'oral Foundation Basement IExt. Walls Fire Place Type Roof ' Recreation ROom JDormer Bath Dinette Floors Interior Finish Heat Rooms l~t Floor Rooms 2nd Floor Driveway LR. DR. BR. FtN. B TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. ............ ...... Approved ...~......~.~...d~..~. .............. , 19~.Z..Permt No.~.~.~&..~ ....... Disapproved a~c ..~~ ......... ~.~"7~'~. ................. ~....~- (Building specter) APPLICATION FOR BUILDING PERMIT Dote ............. .............................. ,,9 ............ 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 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 ~or 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 regulot!Rr~s. ............ ...... ................ (] (Address of applicant) V State whether applicant is owner, lessee, agent, architec~ngineer,_~O.~eneral contractor, electrician, plumber or builder. Nome o~ 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 ~ill be done. Map No: ....... ~ .......... .r~'......~.,~ ............ Lot No: .................... Street and Number ........ ' .................................................................. ~. ............................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....................................................... ~.~ ......................................................................... Intended use and occupancy ..................... ~-Ic'~'~'~ ................ 3. Naiure of work (check which licable): New Building ...... ~i ..................... Alteration Rel~air .................... Removal .................... Demolition .................... Other Work (Describe) 4. Esti',mated,, Cost ........... ~/.~.~.. ....................................... Fee (to be paid on filing this application) 5. If 8welling, number of dwelling units ........... ~ .............. Number of dwelling units on each floor If garage, number of cars ............................ '..~,. ........... 6. If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Diniensions 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 ........................................ 8. Dimensions of entire new construction: Front ........... 2~ ........... Rear ......... Z.~. ............. Depth .....~..~ ............ Hei'ght .............. .~..C~ ........ Number of Stories .......... /..~,~. .......... 9. Siz~ of lot: Front ........Z'..J..O. .............. Rear ....... /../..0. ............... Depth ........ .~...~.~ ............... 10. Daie of Purchase ........................................................ Name of Former Owner ................. , 11. Zol~e or use district in which premises ore situated .................................. 12. Dabs 'proposed construction violate any zoning law, ordinance or regulation? ....... Name of Owner of premises '.:.. · ............. Address .... No. Na~ne of Architect ...................................................... Address ............................................, Phone No. Na)'ne of Contractor ~-¢rJ ~..~/¢f~ Address-~ ~.'.~ No. .................................................... .~..,. Phone PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f property I,ines. Give street and block numbers or descri :ion according to deed, and show street names and indi. whether r~terior or corner lot. 2 33 STATE OF NEW Y(~Kz/. /)L 1 cS ...~..~ ..(~;~'.~.~....... .................... ~....being duly sworn, deposes and says that he is the appli ............... j¢l~'~'~'~"~f"~:Ji~i'~al signing application) above nafned. He is the .............................................................. ~..i~...-d~.~Z ............................ (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 this application; that all statements contained in this application are true to the best of his knowledge and and that ~the work will be performed in the manner set f6rth in the application filed therewith. Sworn to Jbefore me this ............. .?. ......... lay of Notary Piblic, IPUBLIC, Stat,: ~,~ , (Sic ~ture of applicant)