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Home My WebLink About3399-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF o[30UPANP. Y No. Z' 2933 ..... Date ............ November' · '13'" 19'67 THIS CERTIFIES that the building located at . l~,erl~ng. Road ........... Street Map N[lassau. Farfl~lock No ............. Lot No. 12~; .... C!ltchogue'V' .1~ .?f-~ .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... Y~l'~h ' ' 1~ ' ' 19.15'7 pursuant to which Building Permit No. 33'99Z' - dated ........... ~arch' '16' ', 19.67' 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 Privat'e ' one' 'fami'i~, ' d~te i ling ....................................... The certificate is issued to · 8t'relly- -H ~. t)oyd ....... ~'~Ier ......................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval . 't~o'~'~: '8~' '196~'' 'by' R': '¥i'10:a' ' · "1 ' ' Building Inspecto~ FOB, M NO. l TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3399 Z Permission is hereby granted to: ................. ~,?~.~.?~...~......~.~. .......................... ..................... ..c.~.~..~.~ .................................. ........................... ................... to ~..~.,.~..?..~.,....~..t..z.~...~.,..z...z.~ .................................................................................... pursuanrt to application dated ............................ ...l~....:~....~. ....... .~.~. ....... , 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 (Give deed location) ' / ~;~ have been inspected by this department and found to be satisfactory. *~ict Engineer FOI~V~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................... Application No ............................. APPLICATION FOR BUILDING PERMIT Dote ............... ...... .......... INSTRUCTIONS o This application must be compJeteJy 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 g~wng a detailed description of layout of propertymust be drawn on the d~agram 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 th~s application, the Building Inspector w~ll issue a Buzldmg 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 Braiding 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, addittons or alterattons, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· · . ......... ......... ..................................................................... Name of owner of premises ~..~. L~... .c.~ ~ If apphcant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wil.~l be done. ..~. ....................................... Lot No: ~..~..~. ............ Street and Number ~..~.~.....~..'~ ....... ~.: ....... ............................................................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ~-¢~..~ ...... ~ .................................... b Intended use and occupancy ............................................................................................................................... 3 Nature of work (check which applicable). New Building...../ ..................Addition ...............Alteration ............ Repair ............ ...~... Removal .................... Demohtion .................... Other Work (Describe) ...................................... 4 Estimated Cost~.../..~..~.O.~£...o. .................................... Fee (to be prod on filing this application) / 5. If dwelhng, number of dwelling units ...... /.. .................. Number of dwelling umts on each floor ............................ If garage, number of cars .../. ..................................................................................................................................... 6. If bus~ness, commercial or mixed occupancy, spec,fy nature and extent of each type of use ................................ 7. D~mensions of existing structures, if any: Front .......................... Rear .......................... Depth ............................ Height .......................... Number of Stones ............................................................................................................... D~mens~ons of same structure w~th alterations or additions Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stones ........................................ ~ '-,)" ' ' " 8 Dimensions of entire new construction' Front ............................ Rear ...~..~....~.~.. ........... Depth .m ...................... Heightc'~....L.6..~..~ ......Number of Stories ........ ./ ................. 9 S,ze of lot. Front ./ ..... :/~'c.:~.~, .......... Rear ...,/./.?~..e../..~.: ...... Depth ..~.~.-~..~.../....~. ........... 10. Date of Purchase .... .~:~t/..6../...6...~? .................................. Name of Former Owner ....... I~.C../.&f...~..~.A-~...~.. ..... 11. Zone or use district in which premises are s~tuoted ................................................................................................. Does proposed construction wolate any zonma low. ordinance or regulation? .... ~..g. .................................. 1123 Name of Owner of prem,ses/~..~' [/~d~'~....~Address ~-~ ~'~ ' c'L..¢~....~......~...~Phone No ~ 0 -~ ~'-~'~; Name of Architect ..................................................... Address ............................................ Phone No .................... Name of ContraciJor .~.:.'~.:.....'..~...~. ~ ........ Address , l Phone No .... ;, , PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exishng or proposed, and indicate all set-back dimensions fron property hnes. Give street and block numbers or description according to deed, and show street names and ind~cat~ whether interior or corner Jot. / \ t . / '~-,',~ STATE OF N~ Y~,., . ~ ~ S S ' ~, '. .~~ ~....; .................................... being duly sworn, deposes ~nd soys th~ .... (N~me of indNidu~ignmg ~pplic~ion) ~bove n~med. He is the ....... ~ ........................................................................................................... (~9ntr~ctor,~gent, corpor~fe officer, etc.) Of ~d owner or own~, ond is duly ~u~oriz~d to p~rform or ~M~ performed ~ s~ld work ~nd ~h~s ~pplic~tion, ~h~t ~11 s~fements con~omed in t~s ~pphc~t~on ~re true to the best of his knowled;e ~nd behe ~nd th~f ~e work w~ll be performed in the m~nner set ~orth in t~e opphc~on filed therewith. Sworn to before me this~_ ,; ~ z6'~ da' of //~ 19'~'Z~""}z~ ~" Mot,ry Pubhc, . .... ~ ........................................... ;:; ............... . :...~... c. c,~tv .... (si~tur~2;;~ .................... N0~ARY PUBIC, State of N~ N~ ~2.~34~10 - Suffolk Co~n~