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Home My WebLink About3420-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CEI~TIFICATE OF OP..P. UPANP. Y No. ~ 2~ Date 0el; 2. , 19 6~ THIS CERTIFIES that the building located at ~[Y~[t Iqid(le].~:~ ~ad .. Street Map No. ~ Block No.~ Lot No. ~ ~e~O~. ~,i~ ........ conforms substantmlly to the Application for Building Permit heretofore filed in this office dated ~h- 3~ 19 6~ Dursuant to which Building Permit No. 3~ ~ dated ~h 3~ , 19~Z , was issued, and conforms to a~ of the require- ment~ of the applicable prowsions of the law. The occupancy for which this certificate is issued is P~iY~e · 0~. f~ly. ~well~ .......................... Whe certificate is issued to P~i~.F~ ....... ~ ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Departmen~ of Health Approval ~g 2~ ~9~..~. ~ .~l~i~... FOR~ NO. ~ 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) 3420 Z Dote ....................... 14i~o~....31 ........... , m6~... Permission is hereby granted to: ............. 1)~ .t,~l.mk.. ~im~ ................................... · ....12.....(~eenpe ~t, .. ao~e ~ .............................. .......... %4~.1t~ ..R&lr .G~,~ll~.~... &, I.,, ........... to .~J~.ld.. ne~.. one...famil~...ct~elling .................................................................................. at premises located a~ ..~/..q..M~ldeltnn..Roa~ .............................................................................. .................................... G~eenf~l~ ~. ;.]~.~ ~. · ...................................................................................... pursuant to application dated ........................ J/~J~ ...... ..,~3. ........... , 19.~,~1.., and approved by the Building Inspector. NOel keep same setbauk as Paul Comi';l~l Fee $. ~.. ~.QQ ........... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da.~e Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (~ive deedlocation) have been inspected by this department and found to be satisfactory. Di ~rb~s ~9~r~e~n g in e e r FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE $OUTHOLD, N. Y. Applicat,on No D,sapproved~~......~" INSTRUCTIONS a This application must be completely filled in by typewriter or in ink and submitted in duphcate to the Buildm Inspector. b. Plot plan showing location of lot and of buildings on premises, relationsbp to adjoining premises or pubhc streets, areas, and g~ving a detailed description of layout of property must be drawn on the dmgram which is port of this applicatio, c. The work covered by this apphcation may not be commenced before ~ssuence of Building Permit. d Upon approval of this apphcation, the Building Inspector will ~ssue a Building Permit to the applicant Such perm 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 ~n part for any purpose whatever unhl a Certificate of Occupan, 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 tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ord~n.ances, Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe, The applicant agrees to comply with all applicable laws, ordinances, building code and regulahons. (Signature of apphcant, or name, if a corporat~pn) ..... .................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildc Name of owner of premises .... ~ ................................................... If apphcant is a corporate, s~gnature of duly authorized officer. (Name and htle of corporate officer) 1 Locohon of and on which proposed work wdl be done. M%p No ' . ..................... Lot No ........~..... 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 .......'~.~ ...................................................................................... b Intended 3. Nature of work (check which applicable). New Budding ...... ..ct:. ....... Addition .................. Alteration .................. Repair .................. Re~Dval .................. Demolition .................. Other Work (Describe) ........................................ ~/ /I ~ 1~,~ 4. Estimated Cost .................. ./:.~./. .................................. Fee .......................................................................................... (to be paid on filing thcs application) // 5. If dwelling, number of dwelling units ............................ Number of dwelhng units on each floor ............................ If garage, number of cars ........................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ......................... 7 Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... .Z Height ........................ Number of Stories ............/.~.. ........................................................................................... Dimensions of same structure with olterohons or additions Front .................................... Rear ........................... Depth ................................ Height ........................... ~..~-~..~NumbZ~, of Stories ............................. 8. Dimensions of entire new construction Front ........ ................. Rear ....... ...~...?.....-....'~..... Depth ...... ..~.....?.... .... Height ......... Number of Stories ......... J.~_2.. ............................................................................................. 9. Size of lot: Front ..... ~/..~, .............. Rear ...... ./../r< .................. Depth ...... 10. Date of Purchase ................. .1 ......................... Name of Former Owner ..-.~.. ., ............ ] I Zone or use district in wh ch prem ses are s tuated . ....~... .................. 12. Does proposed construct,on ,~j~,ate any zonings. Iow, ord,nance or::~7 ~,_'t' L/~regulat'°n:~ ...... '"~' "~ ............................ -~1-~ 7 7 ... ~'.~..~..$.~..:.~.~. ....... Address SO U ~-r~ ~ ~ ..... Name of Architect .~.../~...~..?..!..~...?'........~. / ..~....~....~;;~- '" ........ Address ...~.......?~:..., .-er....~....~...~ ...... ~ ~L.~ L/~ f ................................... ........ rnOnephone ~'~;No ~;~. ..?..7.~?{...D'.~.~ .............. Name of Contractor PLOT DIAGRAM Locate clearly and d~stinctly all buddings, whether ex~sting or proposed, and indicate all set-back dimensions fron property hnes. G~ve street and block number or descriphon according to deed, and show street names and ind~cat.- whether interior or corner lot. ~16, .... 117' STATE OF NEW YO..~. ..... ~ Z ~ q S COUNTY OF ................. ' ' (Name of ,nd,v,dua~g~ap,?cat,on) above named. He ~s the .....~r,~....~..-c._c .~....-~L..~.. (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized ta perform or have performed the sa~d work and ta make and f, this application; that all statements contained m fh~s apphcat~on are true to the best of h~s knowledge and belief; a, that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ~ ~ , ~ .........__ o, .............. , :";:'::'" ......... ......................... Notary