HomeMy WebLinkAbout4962-z FOl~!~ NO; 2
TOWN OF SOUTHOLD
BUILDING DEFAItT~EHT
TOWN CLERK'S OFFICE
SOUTHOLD, H. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 962 z
Permission is hereby granted to:
Fee $,.~g~ ..........
at premises located at ............ let" '6 ............~1",~ .......... ~'! ............................... ~ .......
~ 19..,~ approved by the
Building Inspector. · } )
..... Budamg ~ t%~-l~ector
FOBM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, BI. Y.
Certificate Occupancy
No..Z..~.~..~ .... Date ............. Ii. ay .... 21 ..... , 19..7.1.
THIS CERTIFIES that the building located at S~ .~,el~"le~.'t..P.o~,d..Lan~... Street
Map No. Berm,. Pml, Block No ........... Lot No.. ~ ....... ga.t.tituek ... l~.,][, ....
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ......... ~l]~t .... 16.., 19.70. pursuant to which Building Permit No.
dated ............ 3. ep.t;...1fi.., 1970.., 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 .Pr~,~.&te..erie. ff. amil~..dve:~l~ng .......................................
The certificate is issued to . .John .T ,. Reeva ... Okmer .............................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval t4ay.. ~1 · · 3.971. · .by. R., .V~.l.~.a .....
ttous, /~ 1+0~ ...~.,.~,.~..(..-..~.~..~..~]t
Building Inspecto~
Examined ............................. , 19...
Approved ........................................ , 19 ........ Permit No ...... f -. .............
Disapproved a/c .................................................... '.L.~.' ........... r
INSTRUCTIONS
a. This application mUst be completely filled in by typewriter or in ink and submitted Jn duplicate to the Building
Inspector.
b. Plat plan showing location of lot and of buildings on premises, relationship to adjoining premises or pub c streets
areas, and giving a detailed description of layout of property must be drown on the diagram 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 this application, the Building Inspector will issue a Building Permit to the applicant Such perm t
shall be kept on the prem ses ava able 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 Deportment for the issuance of a Buildino Perm t oursuant to the
~Build!ng Zone. Or.dinance of the Town of Southold, Suffolk County, New York, and other applicable Law~ Ordir~nces or
Kegumtions, rar the construction of buildings, additions or alterations, or for removal or demolition, as herein described.
The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations.
(Signori'of opplicant~ or n~'l~ if a corporation)
B~.a.~. Avee. P~.O~ Box .~9~. Hattttuok~ N.Y.
(Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
.............................. O~xLe~..-....~.~J~.~.a,1...~.~.TL'~.~.~,~g~, ................................................................................
Nome of owner of premises ....~..o.~,~...~e....R..e...e.?'...e. ..................................................................................................................
If applicant is a corporate, signature of duly authorized officer.
(Name and title of corporate officer)
1. Location of land on which proposed work will be done. Map No.: ..~..~.8.,~. ......................... Lot No.: ~6
-- IO -e .........................
Street and Number Bennet~s Pond Lane Ma~it-uck, NeY,
Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Existing use and occupancy VACANT
b. Intended use and occupancy ....1~.~.~.~..~.~.~.....~....~...]~...~..E. .................................
3. Nature of work (check which applicable): New .Building ....... ...Z~... ..... Addition .................. Alteration ..................
Repair .................. Removal .................. Demolition ................ .. Other Work (Describe) ........................................
4. Estimated Cost .~.QQ.Q~ .................... .................... Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ...... ~....?. .......... Number of dwelling units on each floor ............................
If garage, number of cars .............................................................................................................................................
6. If business, commercial or mixed occupancy, speci~ nature and extent of each type of use ............................
7. Dimensions of existing structures, if any: Front ..~. ...................Rear ..... ~ ...................Depth
Height . ~ Number of Stories
Dimensions of same structure with alterations or additions: Front............................~ ........Rear ............................
Depth ................................ Height ............................ Number of Stories ................................
8. Dimensions of entire new construction: Front ......... 7.~..I. .................... Rear .....~..,~.? ................. Depth
Height ....... ~.0..! ...... Number of Stories ......'..~...-. ..........................................................................................................
9. Size of lot: Front ....~.~,,c~.l. ............... Rear .....~..3.Q..I. ...................... Depth ....1..~..~..I. ....................
10. Date of Purchase ....... ...~T~....~.~.'/...0. ........................ .Name of Former Owner ........................................................
11. Zone or use district in which premises are situated .]~-,~T~rp'I',G~ .........................................................................
12. Does proposed construction violate any zoning law, ordinance or regulation? .... ~.0. ...........................................
13. Name of Owner of premises .....~..0....~......~...~.~.. ....... Address ..~.....0..:..~....~...?.~ ...................... Phone No.~?.~...-.?]...~......
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ..~....G~...o...],~....~..e...~...e..e...~..e....~.....~.?.~,ddress .~..~...e....~.....~...~. ........................ Phone No. ~.?.~...-..~.?.?.~.
PLOT DIAGRAM .
Locote clearly and distinctly oil buildings, whether existing or proposed, and indicote all set-bock dimensions from
property lines. Give street and block number or description according to deed, and show street names and indicate
whether interior or corner lot.
STATE OF N~.m__ I--
COUN~ OF ...~¢:~ ............ ~*'*'
............................................ ~..~..~ ........................ being duly sworn, d~oses ~nd seys t~t he is the ~pplicont
(Neme of individuol sig~ng oppJidetion)
obove nome& He is the ............................... ~.Q~ .................................................................................................
(Contrector, og~t, co.rote officer, etc.)
of seid owner or owners, ond is duly ~uthorized to perform or h~e performed the s~id work ond to ~ke Qnd file
this opplicotioo; thet ell statements contoined in this application ere true to.the best of his ~owledge ~nd belief; ond
thor tbe work will be performe~ ~n the monner set fo~h in the epplioetion fil~ therewith.
Sworn to before me this
Term ~pires March 30, 19~
S-9
SCHD
SUFFOLK
COUNTY DEPARTMENT O~ HEALTH
Date
Bldg. Permit No.
TO WHOM IT MAY CONCERN:
The sewage disposal facilities for a structure located
~z ~ / (Give deed locatton) J
have been inspected by this department and found to be satisfactory.
Chief of General: Engineering Services
DATE
REVi SION.~
Io L c~~
L~
---./__
UNEXCAV~£D ~
FO UND ~ Ti 0 N
PLA N ....
~-04
ONE ILY RESIDENCE
H.YORK. ARCHITECT
IG ST. SAMAICA 3~., NEW YORK.
PLAN NO...
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OAT~: ONE FA~I LY R~mDEMCE PLaN NO
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