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Home My WebLink About2066-zTOWN OF SOUTHOLD ~UILDING DEPARTMENT TOWN CLERIC'S OFFICE SOUTHOLD. 1~. ¥. CERTIFICATE 13F OOI2UPANCY No.~ ' ~):~'6 .... : ' Date ................. 0~i; ...... ~..., 19~6. THIS CERTIFIES that the building located at ]~/~.. ~tie~O:~y..~Ct ......... Street Map No. ~ ....... Block No..~ ....... Lot No. ~ .... ~O~l~Ot~l ....... ~'~, ..... conforms substantially to the Application for Building Permit heretof, ore filed in this office dated ............. ~'~.~y .....~1~, 19~.~. pu.rsuant to which Building Permit No.~(~$. ~.. dated ' .~l~y .... ~', J9.~, was issued, and conform~ to all of the require- ments '.of the .applicable provisions of th~ law. The .o.ccupancy f. or which this certificate is issued is P~il~a~;~..~ .:[~2~i~ · ~]~.~,l~ ........................................... The certificate is issued to ../~b~;. F, .~,,h~3~lt...~t~t!l~ ....... ~1~S ........ (owner, lessee o~ .tenant) of the afore.said building. .Suffolk County Department of Health Approval ....... I]...t~, ........................... FOI~I~I NO. 2 TOWN OF $OUTHOLD 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? 2066 Z Dote ................. ]~'.. · .' ].8 ........................ 19..~. Permission is hereby granted to: ~..l~e~,.t.. ;t~... ~art ~ ........................................... .......... fi~el~c,~'y~..R~ad.~-..l~outttotd. ................ to ..... ~tt.:[4.d.-.at~.,a~di. ti, o~-.on..az~.-~xi.s~g:...dw~iy~ .................................................... at premises Jocoted ot "H~'c~c~r¥"-Ro'ad'i'"t~es'lat~d'i ...................................................................... .................................................... .~u.1~told,~..l~-.Z:, .......................................................................... pursuant to application dated ............................. ~ ...... .~.~ ................ 196.:3...., and approved by the Building Inspector' Fee $'~', (~O .............. FORM NO. 1 Examined .................. ~ .............. (.., 19.*r .... TOWN OF SOUTHOLD BUILDING DEPARTMEF. IT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved ........................................ , t9 ........ Permit' No ................................. Disapproved a/c .~~.~...:~'~ ................................. *('~*~'i'l'~'i'~*~' *i; ~*; ~) ................................. APPLICATION FOR BUILDING PERMIT Dote ...:~.../....~.. ...................... ,19....~..~ ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port 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 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been gr.anted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the. issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction oF buildings, additions.~or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) [JAddress of applicant) Sto;~e whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. '~'~'i"i'i'~ierofpremises.,~.....~...,...~....~...~ ...~..: ~ ................. If applicant is a corperate, signature of duly. authorized-officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ........... ............. .................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ~ .................................................................................................. b. Intended use and occupancy ...................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..~.~. 4. Est,mated Cost ....~...?~,......~.~..:.0....O. ................................. Fee ..................................................................................... ~ (to be paid on filing this application) 5. If d~velling, number of dwelling units .............................. Number of dwelling units on each floor ........................ If garage, number of cars ......................................................................................................................................... 6. If business, commercial or mixed occupancy, specify natu, Lre.and extent of each type of use ............................ 7. Dimensions of ex st nn structures f any' Front ,.~O ~ Rear ~ ~ ~ r~,,,~ Height........I ~ ............... ~.. Number of Stories .... ~ ................... Din~ensions of'same structure with alterations or additions: Front Rear Dep.,th ............................ Height ................................ Number of Stories ........................................ 8. Dim'ensions of entire new construction: Front......L.~.:..~ ............... Rear ..... /..~."..~ ............ Depth .....L~....'...~. .... Height .....~....~... .......... Number of Stories ......~ ............... 9. Size. of lot: Front ....~..~...~.:.../....~. ......... Rear ..... !...~..?.~..~...~. ....... Depth ..... ~...'~....~...,..~...,. .............. 10. Dote of Purchase ...... ./...~...*~'...~. .................................... Name of Former Owner ......... ~ ..................... I1. Zon~ or use district in which premises are situated ....... ..~...~....~~ ........................... 12. Doei proposed construction violate any zoning law ordnance or reaulation? ..... 13. Name of Ownerofpremises.~...:.?.*...~..~....~..~ Address ~ tl~'~Phone No. -'~' Narhe of Architect ....... ~ ............................ Address ............................................ Phone No. Name of Contractor ....... ~ .......................... Address ............................................ Phone No. PLOT DIAGRAM L_ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lihes. Give street and block numbers or description according to deed, and show street names and indi, whether inferior or corner lot. STATE O~ .NJ~V¢~-?/~, )~c above named. He is the (Contractor~ agent, corporate officer, etc.) of said owner or owners, and is du~y authorized to perform or have performed the said work and to make and this applicbtion; that all statements contained in this application are true to the,best of his knowledge and and that t~ w be performed,in the manner set forth in the app~ filed .~re~/~