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Home My WebLink About3405-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P, ERTIFIP. ATE OF I-IP.E:UPANI3Y No. ~ .2BJ.6. .... Date .............. ~,ll~.. I~., 196.~.. THIS CERTIFIES that the building located at hSf~l~l, l~ .~ ......... Street Map 1~o ........... mock: tso ............. Lot No. ~,.. ~~.~ .i,~ ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... ~... 18.. , 19.$~. pursuant to which Building Permit No.~. 8. dated ........... ~.. ~.., 19.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is .~..~. ~ .d~l~8 ....................................... The certificate is issued to . .~*& .~..~. ~ ....... ~ ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~..1~...~,.. ~.~*..~. Building Inspecttr FOEM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3405 Z Permission is hereby granted to: ....... ~.$....O..v.~.~ .~..~.....~..~...l~.,..~,..~...~levamtt; Itt~vva ......... .¢.~l~.l',~e ................................................. at premises located at .~..~..~....~........~..l[I.~...~.~.tdlk~ ....... ~I~...ZZ, ........................................... ............................................ ~,a~t',m~ea.,~"~.'~e. ......... (~t,e~l~,~ ................................................... pursuan¢ to application dated ...................... i.....~..;1~........~.. ............. , 19...~.~.., and approved by the Building Inspector. Fee $..~,Om.~(} .......... S-g SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH AUG I 8 1967 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. District Engineer District Engineer FO~,~M ~0. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. D~sopproved o/c .~,- ........ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th~s applicabon must be completely fdJed 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 adjmmng premises or public streets c areas, and g~vmg a detailed description of layout of propertymust be drawn on the diagram which is part of this applicat~o, c. The work covered by th~s 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 apphcant. Suc permit shall be kept on the premises available for mspecbon 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 ~ssuance of a Budding Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances c Regulohons, for the construction of braidings, additions or alterations, or for removal or demolition, as herein describe, 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 applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde, Name of owner of premises .. .'...~... .: ...... ~~ ......................... If applicant ~s a corporate, signature of duly authorized officer (Name and btie of corporate officer) 1. Location of land on which proposed work will be done. Map No ....~......~.../.....~. ......................Lot No: ...~....~. ....... Street and Number ...... ..~,..~..~....~.;...~(~,0~..~..~.,.,~?~.~...~,.: Municipahty ,u ~J (/ 2. State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ..... ~..,~:.:=.~.. .............................................................................................. use and occupancy ...~....(~,...~ I ~..~.......~.......~...~.~....~..~.....~..__ ................................... b Intended 3 Nature of work (check which applicable): New Budding ..... z~ .........Addihon .................. Alteration ................ Repmr .................... Removal .................... Demohhon .................... Other Work (Describe) .................................... 4 Est,mated Cost ........ -- ~....~..~.,~...~..~ ............................ Fee ........./....~...:.....cC~... .............................................................. (to be paid 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 business, commercial or mixed occupancy, specify nature and extent of each fype of use .............................. 7 Dimensions of existing structures, ~f any: Front .......................... Rear .......................... Depth .......................... Height .......................... Number of Stories ............................................................................................................. D~mensmns of same structure wffh alterahons or addff~ons: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8 D,mens,ons of ant,re new construct,on. Front ......... .~......~.. ....... Rear ....... .~...Z~.. .........Depth .,.,..~.~...~. ........... He,ght ....... ~.~..~.../. ........ Number of Stones ....~..~ ............ 9 S~ze of lot Front ..... j..~..~...:.' ........ Rear ...... .~.....~.. ............. Depth .~...~:....~...'Z ................ 10 Date of Purchase .... ~./...o~..~..~ ................... Name of,Farmer Owner .~....~....~....-- ~' 11. Zone or use d~stnct m which premises are s~tuated ...... ~'~~ ....................................................... 12 Does proposed construction violate any zoning law, ordinance or regulation~ ..... ~..D..~.. ................................... 13 Name of Owner of premises ~/.:~.,..~.~ ...... Address ...~.~...~.~.:..~...,... Phone No ................... Name of Arch,tect .~.~_d~~.AdOress . . .:.~.... Phone No.,~..F-.~...~..~...~..LJ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro, property hnes. G~ve street and block numbers or descnphon according to deed, and show street names and ~nd~cat whether interior or corner lot. ~, ~ ! STATE OF NEW YORK,-- t S.S. COUNTY OF ................................ ........................................ be ng duly sworn, deposes and says that he is the opplicor " (Name (~ individual s~gnmg app ication) above named. He is the ........................................ ~..? ............................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and fil this opphcotlon, that all statements contatned in this application (~re true to the best of his knowledge and belie and that the work wdl be performed in the manner set forth in the application filed therewifh. Sw°~t~b~lremeth's-'~ '/; ~,b ~,J.~.) ............... ...... ..... ........ . ..... ............................ ~ ~OTARY P0~LI~, b ~ ,~ ~ ~0. 52 3233120 ~u,,~ .