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Home My WebLink About3653-zPOgM 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD. N. P.E:RTIFIP. ATE: OF OOP. UPANOY No. ~.1 ..... Date .............. ~a~l, .26 ......... 19.68 THIS CERTIFIES that the building located at . .W/B.. 8ti. ll~ate-l*-AV$.,.. Street Map No...X;X ....... Block No ..... ~ ..... Lot No..~r ..... ~l{9hO~ .1~'~ ........ conforms substantially Go the Applicati.on for Building Permit heretofore filed in this office dated ........... 0~t .... ~ ..... 19.67 pursuant to which Building Permit No... dated .......... 0e~.. Il ........ 19.6~., was issued, and conforms to all of the require- merits .of the applicable provisi.ons of the law. The .occupancy for which this certificate is issued is .. ~ .... Pl'tv'~te' 'on~ 'fa~:t~y' ~l'I~g ............................. The certificate is issued t~o . '~ell~aX~]:-$kl/&l'a ............. (owner,~" '0~/lXlessee ~o~tenant) ................. of the aforesaid building. .Suffolk County Department of Health Approval .. 4Tal~.. ~,..'[~8 ·. by'. l~.. ~.~].~ .... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N.o BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ..... ~......~:~:~..s......,./...q..~,...~.~ & ................. ~J~.~e ......................................... to ~..~..~m~..~f~y...6~e~.~,~ ................................................................................... at premises located at .....~..~.~'~!.~.~...~,.~.~.: .................................................................................... ........................................ g:~t,~&q~e.....~ ................................................................................. pursuan4' to application dated ....... .................. ~t, ....... D ................. , 19~'...., and approved by the Building Inspector. Fee $~e.QO ............ SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No. Q~- s) ~. 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. Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ............ Approved ......................... .~.~. ............ 19 ........ Permit No. ~,~.~...~.,..~.'...i~,.. Disapproved a/c~ ...................... ... (Building Inspec:r) APPLICATION FOR BUILDING PERMIT Date...~./.~.. .................................. 19.~...7.. .... INSTRUCTIONS o. This opplicetion must be completely filled in by typewriter or in ink and su~amitted in duplicate to the Building Inspector. b. Plot plan showin§ location of lot end of buildings on premises, relationship to edioining premises or public streets or areas, and giving o detei[ed description of layout of property must be drown on the diagram which is port of this Iocetion. c. The work cov. ered by this application may not be commencf~d 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 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) .......... ........................... (Ad~¥ess of applica6t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~.'. ...................................................... If applicant is a corporate, signature of duly authorized officer. 1. Locat on of land on which~proposed work will be done. Map No: ...~, ....... ~ ................... /.~o~' · '~ No: ...................."~ Street and Number ........................ ? ................... ~.....-r~;~.). ....... ~% ......................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. £xisting use and occuponcy ........ ~..~:rm..-....~ ........................................................................................... b. Intended use and occupancy ....... ..~....?......~.~ ...............~. ....................................................................... 3. Na ute of work (check which applicable): New Building ...... ...~. · ........ Addition ...... J ............. Alteration Rel~air .................... Removal,,,~ ~, .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .............. ~..~'.1..~__ ...................... Fee .......... ~ (to be paid on filing this application) 5. If c~welling, number of dwelling units ........... ~. ................... Number of dwelling units on each floor ...... ./ If ~arage, number of cars I 6. If Jbusiness, commercial or mixed occupancy, specify nature and extent of each type of use .... 7. Dimensionsj of existing structures, if any: Fro~t ............................ Rear ............................ Depth Height ............................ Number of Stories ............ D~qnens.ons of same structure with alterations or additions: Front ................................Rear Depth .............................. Height .............................. Number of Stories ................................ 8. Di~ensions;f entire new construction: Front.....~ ....... Rear .... ..~.....yi ............ Depth ..'.~.....~.' .......... Heiight .......... ~ .............. Number of Stories ............................ 9. Si~e' of lot: Front ...L..~ ...... Rear (. ~ ......... Depth ..~.....O..~.~. ....... 10. Dote of Purchase ....~./..~.~...~'...'~. ............... Name of Former Owner ..-~,/~ 11. Zcne or use district in which premises are situated"~'""~m"~) O ............................. 12. Does proposed construction violate~._ ,t~- 'any zoning law, ordinance~ ,..-~. ' ~ ,°r regulation? ...~......'..~. .......................... 13. N~,me of Owner of premi,ses..~~dress,,., ~'. ,-,'~ ~ ,~ ..~~..~...~Phone~ ~ NO ............... N( me of Architect,..~'~....~-m~.~.: ...... Address .~..~..:~..~.:~....Phone NO ............... ,,,,me of Contractor.~....~.....AOdress ..~-~.....~...=~.~...:f.~Phone-- ~ ' NO"/~....~...~.~ ~ PLOT DIAGRAM Locdte clearly and distinctly afl buildings, whether existing or proposed, and indicate all set-back dimensions f property iines. Give street and block numbers or description according to deed, and show street names and indk whether Interior t~-ij or corner lot. STATE (:F NEW YORK, ) S S. COLJNT~ OF ............................ ) (~----~)~ ~.~c..~' .............. being) duly sworn, deposes and says that he is the appli. (Name of individual signing application) above na~ned. He is the ...... ~.....t (Contractor, agent, corjborote officer, etc.) of said o;wner or owners, and is duly authorized to perform or have performed the said work and to make and this appl~icatJon; that all statements contained in this application are true to the best of his knowledge and a~ thatl the work will be gerformed in the manner set forth in the application filed therewith. )m ~te