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Home My WebLink About3400-zFORM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BERTIFIBATE DF BBBLIPANBY No. S 2~+~ Date , -. JU~y. 9'- , 19.67. THIS CERTIFIES that the building located at ~'~ .Gtt%~ ~ ~. Street ~ap ~~ ACr~o~ . Lot No. l, G~pO~,. H,~, ......... con[orms substantially to the Application for Bufldin~ Permi~ heretofore filed in this office dated ~, 2~ , 19 ~ pursuant to which Building Perm[~ No. ~. Z dated ~ [~ , 19 6~, was issued, and conforms to all of the require- ments of the apphcable provisions of ~he law. The occupancy for which this certificate is issued is ~i~te one. f~&!y, d~l~ ............................... The certificate is issued to ~'l~'. ~..¢h~i. · .F~r~l& ...... ~ ........... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of ~ealth Approval ~e ~ ~9~ · ~.~ .Vi~ .. Building Inspector FOP~I NO, 2 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? MOO Z Permission is hereby granted to: To~a~..k. Con.~t;~ I ........................................... U~....~..~......~f~gF.& ChalnM.an Fa~r~]~ ..................... ~250.....Sunr~ sa .. HighwaT. ........ ....................... ~-~A]~e~...l~,~., ....................... to ..1~1,;~.. Xinu... 9~e... fa~y...d~e~ ~u ~ .................................................................................. at premises located at ..lo.Ll..Fflrdham..Acr. es ............................................................................ ............................ J~/.~.....G~,..P~d..~ar~e ..................................................................................... pursuan~ to application dated ............................... ~8~....~.~ ........... , 19.6.~..., and approved by the Building Inspector. NOTE M~li~um setback 3~ ft from any highway line or in line with other dwellings Fee $..1...0..e....0~.. ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. JUN 8 1967 TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Givez~eed location) ! ~ have been inspected by this department and found to be satisfactory. District En~ine~ District Engineer NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE om ned ...... ....... , 'l Approved ........................................ , ]9 ........ Permit No. D~sopp roved o/c ............................................................... ........................ ................................. Application No. ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and giving a detmled 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 will issue a Budding Permit to the applicant. Sud 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 Occupanc' shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a Building Permit pursuant to th- Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, addmons or alterations, or for removal or demolition, as herein described The applicant agrees to comply w~th all apphcable laws, ordinances, building code and regulations. (S.gnature 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 .~.~...'~..~..~..~.....q.~...~..z~.'..~.'~...~.......~..~..~...~.~e..]-...~. ..................................................................................... If ~/D~cont is a corporate,~ature of du[y authorized officer. ........ ...... (Name and title of corpofat~ officer) 1. Location of land on which proposed work will be done. Map No' ...~1~..$.~ ............................... Lot No: ..~ ............... Street and Number .... ..~./..~'~g~..~.~.~T~.~.~et~t~.$..~.~.~.~]~.~..~.~...~..~.~.~..~...~..~.~.~9~. ................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ..~..o.....e..~.~J~..~.~.~..~....b..~..~..]r.4..~.~.~. ........................................................................ b. Intended use and occupancy ..... .o...~..e.....f.~..~.~.....d...w..e..~...~.~...?=~ ........................................................................... 3. Nature of work (check which applicable): New Building ...~ ............ Addihon .................. Alteration ................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4. Est,mated Cost ..~.~..~.9..0.,0..:. ....................................... Fee ......................................................................................... (to be paid on filing this application) 5. If dwelhng, number of dwelling units ~....~.,..e~,..J:..]:.~. ......... Number of dwelling units on each floor ........................... If garage, number of cars ............. .o.b.e. ...................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................... 7. D,mensions of existing structures, if any: Front .......................... Recur .......................... Depth ........................... Height .....~.$. ................... Number of Stories ............ ~ ................................................................................................ D~mensions of same structure with alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..... ~.~. .................. Rear ....~ ................. Depth ..~.,,~.~. ................... Height ...... .1....5..~ ................ Number of Stories ..... ~ ..................... 9. Size of lot: Front .........~..0.,~..* .......... Rear ..... ~.~..~.l.&..'..~. Depth .~....2'..,~.~/....'h. ........ 10. Date of Purchase ..... .D...e.g.?....8..~....~.~)..~.,6. ...................... Name of Former Owner ,~n...~.~.~i~,...~t),~.:~ .......... 1 I. Zone or use district in which premises are situated ..... .Cr.~...~.~.~.~;['.t~ .................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ rag. ....................................... 13. Name of Owner of premises~.~.r..:C.;E...~..a~..~.~.~,~. ......... Address ..J,.~.[...G~.~,G~..,T,~F,61.. Phone No. Name of Architect iiTil~r~l~l~[ .................... Address ............................................ Phone No ................... Name of Contractor ..~..o.~t..e,.7;'~...~9.1q, f[.l;,~.gt.9.~.q~l.~...Address .5.;~.~.(}...~.t/,~;C..:[~.~t..~' ..... Phone No~D...~.0.~g. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fror property hnes. Give street and block numbers or description according to deed, and show street names and ind~cal whether interior or corner lot. STATE OF NEW Y~RK-/] ~ ~/~ 1 COUNTY OF .... Map of Fordham Acres Section one Lot one .......... ..~..[.,?..~.~....S.,?.~.~..e.~.~..l ................................................. being duly sworn, deposes and says that he is the applic (Name of indwidual signing application) above named. He ~s the .......... ..C..o...~.~.a..q..~..o..~. ................................................................................................................. (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 applicahon are true to the best of his knowledge and bel and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ .2. ~.. ............. day of ........ ' .... ........... ............ ...... Not~u"Gbq%~, ~ · . ~ ' ,~ t .v~Count~; ~ ,/'~ (Signature of applicant) ?. - ~ ,c~naw t ~. M. /PA YNOR Z/oen sed'Z~nd Burv'eyor