The URL can be used to link to this page

Home My WebLink About2928-zFOP~M ~0. 4 TOWN OF SOUTHOLD BUILDING DEPAHTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF O00~]~ANCY No. z. Date .................. ~e.. 8 .... , 19.66 THIS CERTIFIES that the building located at .. t~/~...Hiawa~0ha~ .Pal~h .... Street Map No... XX ....... Block No...~ ....... Lot No. ~ .... ~thO~. · .t~, .~.~ ......... conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ............. ~IO~.. ~,.~ .... 19~. p~rsuant to which Building Permit No..~ .~ dated .......... l~,...~[.~. ..... 19.~.~, was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The occupancy f. or which this certificate is issued is . ~.~.a$~..O~./'~JTlil~.. ~We~'[~l~g .......................................... The certificate is issued to . .~Ylll~...~le8 .......... OWlle~* ......................... (owner, lessee or tenant) of the aforesaid building. ~Suffolk County Department of Health Approval .... ~TIIlI~...6,~..1[~66...]~y'. 'R~..Vl[.~.q.a. · · Building Inspector\ FOI~M ~0. ~ 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) N? 2928 z Permission is hereby granted to: 6aa ..Al~e~....&/G.-/,~sm. ~,t.:L~- -ee ...................... ......... Gu~he~u~ ................................................. t o. ~u~.Z.d...new...one.. ~.ar~..:L3... ~we_~: .~n¢ ..................................................................................... ct premises located at ..... .]{~,~6~a.l.~...13a~h ............... ~'l~11~..'e/a~'~el~ ................................ .................................................. ~ eu~ho.Z~l,r .... ,q, ¥~. ............................................................................ pursuant to application dated .................................. ~'O~.,.....;~..~ ....... 19.~.~.., and approved by the Building Inspector Fee $....]~O.00 ........ Building Inspector SUFFOLK COUNTY DEPAR2~ENT OF HEALTH TO WHOM IT MAY CONCER~.. The sewage disposal facilities for a structure located (Give de~d location) ' have been inspected by this Department and found to be satisfactory. Distri'ct Engineer NO. 1 T~WN OF SOUTHOLD BUILDING DEPARTMENT TOwN CLERK'S OFFICE SOUTHOLD, N. Y. E×emi,ed ........ ......... , · , z Approved ........................ : ............... , 19....i'~.. Permit No. '~'' c, , z, '- Application No. ~:../...?....~...~.:'. ....... Disapproved a/c ..................................................... ;~ ...................................... ................................. ................................. 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 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 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 Department for the issuance of o 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, building code and regulatio~ns~ ............................... ......................... State whether applicant is owner, lessee, agent, architect, en/~i/~er, general contractor, electrician, plumber or builder. ..................... ...................... eo'ownerof em' 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,: ..... ~/~.<~/)./.~.~..'.IC4...~.-Z~Lot No.: ........................ Street and Number ..... ,~.l...~.....x~...~..?~7..~..~. ........... .~...~:...~-..~. ....................................... ~ ~ t~.~.~.'~.~l..O..~ ~..~.. .................. 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 occuponc¥ ................. ..~.....,.x~. ................................................................................... 3. Nature of work (check which applicable): New Building ..... ~ ...... Addition .................. Alteration .............. Repair .................. Removal .................. DemoHtian .................. Other Work (Describe) .................................... 4. Estir~ated Cost ........... ~..~'~.~..~..C). ............................... 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 i 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 ............................................................................................................ Dim~ensions of same structure with alterations or additions: Front .................................... Rear ....................... Dap;th ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ ~.....~.. ............. Rear ............................ Depth ......~.(..~. ....... 11. Zonp or use district in which premises are situated ................................................................................................ 12. Doei proposed construction violate any zoning law, ordinance or regulation? ..... .~...~. .......................................... Name of Architect ...................................................... Address ............................................ Phone No ................. PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fn property li'nes. Give street and block number or description according to deed, and show street names and indic~ whether interior or corner lot. STATE aFl NEW YORK, J, 1' S S .............. ~ ...... ~.~.? ......................................... being duly sworn deposes,and says that he is the applio '(NamfJof individual signing application) above named. He is the ......................................................................... ~r~¢..~..'~..;~ ............................................... ~ '"~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this opp dar on; that al statements conta.ined n this application are true to the best of his knowledge and belief; that the wgrk wdl be performed ~n the manner set forth in the application filed therewith. Sworn to b~efore me this Notary Publi ....... County , of applicant) [ / MARION A RE6ENT