HomeMy WebLinkAbout5316-z FOEM NO, 2
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISE~S UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
N? 5316 Z
Permission is hereby granted to:
......... E~...~b.~ ......
.............. .~......~.~r.~,~, .~,~...~;.,. ...... i .................
...................... ~(~;~ ~'~ ~%~ ....... ~,,;Z.~ ........................
to ..... ~1~t .. ~.{ .. ~r,~...f~ 3,~r...~.~ 2:1~ ~g ...............................................................................
pursuan¢ to application dated }~' ~'~ ~,
............................................................ , 19 ........ and approved by the
Building Inspector.
Fee $.~..~.".~ ...........
FORM NO. 4
,,
TOWN OF SouTHoL~
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate Of Occupancy
THIS CERTIFIES that the building located at . ~O~Or~ .~,,& ,M~O~, ~:~tStreet
Map No ~'~t~t;~ Block iNTo..lgtg. .Lot No. ~...l~lt¢~]aO].ll. I~,~X, ........
conforms substantially to the Application for Building Per'mit heretofore filed in this office
dated ............. ~,~r,.. ~$, 1~.~,. pursuant to whiCh Building Permit No.
dated ......... lq~,3~.. ~ ......, 19~.., was issued, an~ conforms to all of the require-
merits of the applicable provisions of the law. The occupancy for which this certificate is
issued is .. ?'~A.Val,~, .~¢~..~,am~ .1.~ .4Wg*l&~tlag .... ~" 'i .............................
The certificate is issued to .t~ari~ .l~o~h~l~ ....... i~ ...... : ....................
(o..Wner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .~1~t~1....~1~...~.~ .t~t R,
UNDk,'RWRITERS CI~RTIFICATE No. '~8~'; ......... i .............................
HO US k; N klM B 1! R. ~9,.~ ....... Street..l~Ol~.~l~a. t48.//~. ~. !~ 1~8~O~.~1 ~ P&~l~t ...............
Building Inspector
FORM NO. 4
TOWN OF SOUTHOLD~
BUILDING DEPARTMEL~T
Town Clerk's Office
Sonthoht, N. Y.
Certificate Of Occupancy
No. ~0~; ...... Date ...... ...:.&~ ....
THIS CERTIFIES that the building located at , ~ .1~. & 't~lt~t~l'8' 1~/~Street
Map No. 0~0~0~ ... Block No..1~ ....... Lot No .... ~11~...t~O[~lO~[.g[· ~.5[~ ........
conforms substantially to the Application for Building Pe~cmit heretofore filed in this office
dated ............. ~},.. ~., 19.~F~. pursuant to which Building Permit No. ~¶~..
dated ......... ~1~" ' 'tS ..... , 10~¢I.., was issued, an~t conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is l;~J~,~a~tl '011~
The certificate is issued to 'FlPlItl~ 'D~' 0~o~'a~'er, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .&~..
UNDERWRITt!RS CF~RTIFICATE No..~1~ ........................................
HOUSI~ N UM BER. ~0 ....... Street..~. ~ ~. ~ '~0~)~' ..............
,
Building Inspector
$-9
SCHD
SUFFOLK COUNTY
DEPARTMENT O~F HEALTH
Date
Bldg. Permit No. ~9~'~?,/z<' ,~-<
TO WHOM IT MAY CONCERN:
at
The sewage disposal facilities for a structure located
(Give deed l~ca~ion)
have been inspected by this department and fDund to be satisfactory.
Ob;,, D~s'trict Engineer
FORM NO. 4
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
Town Clerk's Office
Southold, N. Y.
Certificate O[ Occupancy
No.~l~. ...... Date ........... ~pl'~.... ~.~ ..... , 19.
THIS CERTIFIES that the building located at . l~O~l~ .~. & ,l~el*l~. l~TM
Map No. ~... Block No. ~ ....... Lot No .... ~l~[...~014. ]ll,]~e ........
conforms substantially to the Application for Building Permit heretofore filed in this office
dated ............. 1~.. 2~['~, 19 .~/3. pursuant to which Building Permit NO:
dated ......... I~y. · ~]: ..... , 19~.., was issued, and conforms to all of the require-
ments of the applicable provisions of the law. The occupancy for which this certificate is
issued is .. 1~$~,~ .~..~f~,~ .dW~],l~[ ......................................
The certificate is issued to .ll~,~ .])~1~ ....... ~..~ ...........................
(owner, lessee or tenant)
of the aforesaid building.
Suffolk County Department of Health Approval . .&~**~,.. ~1~. i~'~ .b~r. 1~..~&..
UNDERWRITERS CERTIFICATE No. '~'~8y' .......................................
HOUSE NUMBER.~ ....... Street. ~ .~& ~.~lJ...~]~ .~a&~l~l[ ...............
l~OltM NO. ~
TOWN OF $OOTHOLD
BUILDING DEPARTMI~NT
TOWN CLBRK~$ OFFI¢w
SOUTHOLD, N. Y.
BUILDING PERMIT
(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL
COMPLETION OF THE WORK AUTHORIZED)
5316 Z
Permission is hereby granted to:
.............. .~.....~e~..&~e...ll~ ........................
..................... ~i~-sl~l~ ....... l,,Z.~ ........................
to ..... I~d~..m..m~...t~r...d~m~ ...............................................................................
at premises located at ...... ~il..~..&..l~.~e~..l~l~ll .........................................................
................................................. ~& ........ ]!~', ........................................................................
)(IL~ ~ 19..~ and approved by the
pursuan~ to application dated ............................................................ , .,
Building Inspector.
Fee $ .~1.~.0..t~. ...........
Building Inspectorf
BUILDING DEPARTMENT . .
'TOWN GLERK'S OFFICE ~,//~z ~o C. ~
~THOLD, ~. ~. ~ ~ ~
................................
.............
................................................................ ~~ ........... ~ ~
....................... .....................
~ .................... ~ ......... .~L...., ~.Z~. .......
o. This opplic*tion mu*t be completely {ill~ in b~ ~pewriter or in ink ond submitted in duplicate to th* Buildin~
Inspactor.
b. ~lot plon showino I~ofion o{ lot ond o{ buildinos on premises, rolotionship to ~djoinino premise~ or public
~re~s, ~nd ~ivino a dot, lied d~cription of layout ofprope~ must bo drown on tho dioorom which is
c. The work covered by this opplic*tion m~y not be comme~od b~fore issuance o{ Buildino P~rmit.
d. ~pon opprovol of this ~pplic~tion, the Buildin~ Insp*ctor will issue o Buildino Permit to th~ ~pplicont.
sh~ll be kept on th~ pr~m ses ~voi ~b e for in~poction throughout the pr~re~ of th* work. '1
e. ~o buildin~ sh~ll be ~cupiod or used in whole or in pa~ for ~ny pu~ose whot*ver until ~ C~i{ic~t*
sh~ll h*v$ been ~r~ntod by the Buildino Inspector.
APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of a Building Permitpursuant to thet~-
Building Zone Ordinance of the'Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances
Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein describec~N'~Jk
The applicant agrees to comply with all applicable laws, ordi nonces, building cdde, housing code, and regulations.
· ESw. Tebia & Sen
(Signature of applicant, or name, if a corporation)
1+0 Gerar8 Ave E. Malvern L.I. (Address of applicant)
State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.
CSntracter
Frn~ Denahue
Nome of owner of premises ............... ~ ..................................................................................................................................
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.: ....... ~ ........................... Lot No .......... ~ ........
Street and Number .......... .~.~.~. He~to~ La & ~/..$ lvla~ors Path S®uthoZcl
~'1--- 775'0 Municipality
2. State existing use and occupancy of premises and intended use and occupancy of proposed construction:
a. Exisiting use and occupancy ...l[t~,~a,13,~.i.],~lD,~ ..............................................
b. Intended use and occupancy .......... ~eL..:~a~l:l,l,~..~we,],~,l~ ........................................................................
3. Nature of work (check which applicable): New B,~i~ing .... ~ ...... Addition .................. Alteration ..................
Repair .................. I~moval .................. Demolition .................. Other Work (Describe) ........................................
20 · 000 + ""
4. Estimated Cost ~v,vv
...................... ~ ................................. Fee ..........................................................................................
(to be paid on filing this application)
5. If dwelling, number of dwelling units ..... .~.e. ................ Number of dwelling units on each floor ....: .......................
If garage, number of cars ........ I~z).eL....(~lz~l~Z'...~La~l.-~e.) ..........................................................................................
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 ....................
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 ~' ' Rear ...........~.~.. ............ Depth 28-6
Height .................... Number of Stories ....................... ~.D,e .........................................
9. Size of lot: Front ..... .~.Q0 ................ Rear ........ .1.0~r. .................... Depth ......... .~.~.6.~.../....~.~.~
10. Date of Purchase ........................................................ Name of Former Owner .......... .0.~,~.~.OZ~. ............................
# #
11. Zone or use district in which premises are situated ......... ~,.....0,~,S~ .......
12. Does proposed construction violate any zoning law, ordinance or regulation? .............. Z).I .........................................
13. Name of Owner of premises~...~.~......~...e.~..~....~.,e. ....... Address ............................................ Phone No .....................
Name of Architect ...................................................... Address ............................................ Phone No .....................
Name of Contractor ....~/.~..~,®~'L&.~.S .............. Add ;ss ...~..~.~..e.~.T~ .................. Phone No .....................
~icate all, set-back dimensions from
.'cording to deed,~n icate
PLOT DIAG[
Locate clearly and distinctly all buildings, whether existing
property lines. Give street and block number or description
whether interior or corner lot.
STATE OF N~O~ ~--
COUN OF ...........
................................................................................................. being duly ~orn, d~o~s and says t~ he is the applicant
(Name of individual signing application)
above named. He is the ................. C~[~[~ .................................................................................................
(Contractor, agar, co~orate officer, etc.)
of said owner or owners, and is duly authorized to perform or h~e perfo~ed the said work and to ~ke and file
this application; that all statements contained in this applicati~ ~re t~e to the best of his knowledge and belief; and
that the work will be performed in the manner
Swam to before me this
................. ............................ ......... , _.
x / ...............
Nota~ Public,~~~ ...... ~.~Coun~ (Sig~a~re of ap~[ica~ ........................
~ JUDITH ~.
~ol~r~ ~ J~ ~JlJl 0J New York
Ho. 5~(~3~4g63. Suf/olk Cou~ty
~mmiss~, ~s March ~ ~/~
S-9
SCHD
SUFFOLK COUNTY DEPARTMENT OF HEALTH
Date
Bldg.
Permit No. ~,,.~/~' .~'~
TO WHOM IT
at
!
MAY CONCERN:
The sewage disposal facilities for a structure located
(Give deed 1Bcation) 0
have been inspected by this department and found to be satisfactory.
District Engineer
TOWN OF SOUTHOLD
BUILDING DEPARTMENT
TOWN CLERK'S OFFICE
SOUTHOLD, N. Y.
NOTICE OF DISAPPROVAL
File No .................................................................. Date .............. ~..---~. .............. ../.~ .............
/
.~.~...~~...~ ............................
PL~SE T~ NOTICE that your application dated ....... ~.....f..~ ...............
..... ~...~.m~....~.....~....~., ............... ~~~~ ...........
.......................................