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Home My WebLink About2888-zFOI~lV[ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. ¥. OEI~TIFIOATE OF OOEIUPANOY No. Z.. 2b~6.8 ·. · Date ............... .J?l.~.y....%? ........ 19.66.. .... '''~ ~'~ ~ 0 W (~rsh Road) THIS CERTIFIES that the buHd~ng ~o~ee a~ A~;.~. ~. ~9~ .~. ~ ............. Street off W/8 Mill Lane ~ L.I.So~ ~ap No. ~ ....... Block No... ~:% ..... Lot No.~. .... ~. ~.~ ............. conforms substantially to the Application for Building Permit heretofi~e filed in this office dated ............ 0*t .... 6 .... 19.6~ pulrsuant to which Building Permit No..~.~. dated ............... 0~..~.., 19~., was issued, and conforms to all of the require- ments .of the .applicable provisi.ons of the law. The .occupancy f. or which this certificate is issued is .. PRIFale..Q~. ~$~. ~)~Q~g ......................................... The certificate is issued to ...~a~l .i~..~i~a~t. · ~ .... 0~2.. :... * ..... :; ......... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .......... ~* ......................... FOI~M 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? 2888 z Date ..................... Oo, to~er......7. ............... , Permission is hereby granted to: (t~.e~t..~t~,~],l. ................................................. ......... tN.t., l~d.....~.l~t Lt .. La .............................. .................. P. econl~ ............................................ to ..~.~.Z...(].....~..,...~,~j ;~.~ ;i,.~.11...Qr,..~,X¢ ...e,l~ ~G :l;~.~,g...~.~.e .~ ],;[ng ......................................................... ct premises located at ...~/.~.....~.~...~.,.~).t.~.....O~...~.J~...J~],],..~I~1L~I ........................................... ............................................... ~..e..q.~..n..~.C. ~ ,.... ~ ,. ~, .................................................................................. pursuant to application dated ................................ .0..~...~. .......... ~ .......... 19.~..., and approved by the Building Inspector Fee $. ,~...*..0....0. ............. ..... ~:.~.>...:: .......... ::.....': ........... ~:.f.::.( .......... ~ ............ ' Building Inspector FOBM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~......Z ........ ,19..~:~T Approved t 19...~.~.... Permit ~.~.~...~..'...~.'....~.........~'-- .......................... ~ ............. , No. Disapproved a/c ............. ~'~'~'~'2 .........~ ......................................... ............................ ............. ..................................... (Building Inspector) Application No.....~...~....~.'.~. ...... APPLICATION FOR BUILDING PERMIT Dote ............. .q.~..Z ........~......., ................ , 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 shewing 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 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 permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shell 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 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, as herein described. The applicant agrees to comply with all applicable Paws, ordinances, building code and rec~lations. (Signature of applicant, or nma e, i~c~carporation) '" -- .......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name 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 P~iL).A'I'~' Municipality 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. Estimated Cost .................. : ........................................ 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, specify nature and extent of each type of use ...~ ............ 7. Dimensions of existing structures, if any: Front ......'~....~.I...~..~[ ......... Rear ..~...~...l..G..'.[ .............. Depth ..~....'.~..~...~...'.'... Height ...... .J...7. ............. Number of Stories ..... ! ........................................................................................................... Dimensions of same structure with alterations or additions: Front .....~....~...f...~...'.'. ............... Rear ....~.i..~...~; ........ Depth ....~...~..!...~..~'. ............. Height .......L~...~ ............. Number of Stories ........ ~.. ..................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories .......................................................................... , ........................................... 9. Size of lot: Front ....... ...~'....~'...L ......... Rear ......... .?...~'~.../. .............. Depth ...~..O..~.'..~..~. ~-~-~ 10. Date of Purchase .. ! ...Name of Former Owner ...J...0.~....~....c~......°~...l~l...°Y..~.. ......... 11. Zone or use district in which premises are situated ......... ~ ........................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... _h~/....O.. ............................................. 13. Name of ~Jw p ........................................ aa ess ......................................... ;.. Fhone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back 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 NEWARK, -- ~"S COUNTY OF ~~' ' .......... ~ ................... boino duly swom~ doposos ~nd soys t~t he is tho opplic~nt (~me o{ individuol sionin~ opplicotion) obove nome& He is the ......................................................................................................................................................... (Controctor, o~ent, corporote offic~r~ etc.) of soid owner or owners, ~nd is duly authorized to perform or hove porformed the s~id work ond to m:ke and file this opplicotion~ thor oll statements conto, ined in this opplicotion ore tree to tho best of his knowled~o ond belio{~ ond thor the work will bo per{ormed in tho manner set fodh in the opplicotion filod therowith. Sworn to before me this ~ ...... ~,. ........ ..... o, ....... ............ , r ' .................. l MARION A REGENT NOTARY PUBLIO, S~ate ol New York ~ No. 52-3233120 Su~iolk County Term Expires March 30, 19~