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Home My WebLink About3222-zFOR~ ~0. 4 TOWN OF SOUTHOLD EUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. ¥. ClERTIFICATIE ElF o~.~UPANCY No..~. 2~... Date ................ ~p~:e~ber. 16, 19.66. THIS CERTIFIES that the building located at . ~[hol't~ .l~c~td ................. Street Map No. ~,..~r~ock No ............. Lot No. ~/$.~ .~...Or~np.q~,. conforms substantially ~o the Applieati. on for Building Pemit heretofore fil~ in this office dated ......... ~op~o~e~. l~ 19.6~. pursuant to which Building Permit No. dated ............ 8ep~e~be~16 196~., was issued, and conforms to all of the require- men~ .of the .applicable provisions of the law. The .occupancy for which th~ certificate is issued is . ~iVa~ · ~e. ~aml!y..dwall~g &. ~q~9.~. g~g9 .................. The certificate is issued %o .~e~O. AngO~. ~. ~fO .......... ~e~8 .............. (owner, lessee or tenant) of the ~oresaid building. Suffolk County Department of Health AppDoval .......... ~'.'R~ ......................... Building In~ct~ FO~,~ 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? 3222 z Date .............................. ~e~t~tal~]F..~J~, 19:1~.. Permission ts hereby granted to: .... ~,nltO:~. & -.6e~r~,x,,_~..Jtngmu~ .................. .............. F~..... ~..~.:l,~a~ ........................... ................ t~bx'~c~..l~ .............................. to .]~t~l~.. ~1~..~t.4 ~1~. On..2~.. e]K~.St~.ng..d'~lt-.~-~ .:L*lg ......................................................... at premises located at T-'~t...~..&-.~f8 ......... Gmnpo~.t..~qh~tl ........................................... ............................................ ~[h~,~..D~e.~..-.. ~eel~p~rt.~...l~,,.Y., ............................................. Building Inspector Fee $...~.~... .............. Building Inspector FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ] 9 ........ Permit No ................................. Approved ........................................ , D~sapproved a/c .............................................................. APPLICATION FOR BUILDING PERMIT .... .................... INSTRUCTIONS a Th~s applicahon must be completely filled in by typewnter or in ink and submitted in duplicate to the Buildin. Inspector. b. Plot plan showing location of lot and of buildings on premises, relahonsh~p to adjoining premises or public streets c areas, and g~ving a detaded description of layout of propertymust be drawn on the diagram which is part of this applicatior c. The work covered by th~s apphcation may not be commenced before issuance of Building Permit. d. Upon approval of th~s application, the Budding Inspector will issue a Budding Permit to the applicant. Suc permit shall be kept on the premises available for inspechon throughout the progress of the work. e No budding shall be occupied or used ~n whole or m part For any purpose whatever until a Certificate of Occupanc shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Budding Department for the issuance of a ~,crtl'd~g Permit pursuant to th Budding Zone Ordinance of the Town of Southold, Suffolk County, Ne)*r~and oth/efXappl,~able Laws, Ordinances c Regulahons, for the construchon of buddings, additions or alterationS', or for JemovqJ/or dern~lition, as herein descnbec The applmant agrees to comply with all apphcable laws, oral,nancy, buell '/~rx~'lations. (~' ~:2~l~,~l~e,Z corporat,on) ...... ~ ~ (Address of applicant) ~ ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde ....................................... ...................................................................................... Name of owner of premises ............ ~./~..~..~....~....O.../~.~.~..~.~/~.p.....~../..~....~../..~..~,,...C..~...TZ..~.~.~ ........ If applicant is a corporate, signature of duly authorized officer. 1. Locat,on of land on whch proposed workw be done Map No/.~,~/?..G.F...~..~/~;.~...~..~.z'...~.B..0.~.~Lot No' 0 ~ ~ ~ ~ ~7' ' ~Z' ........ Street and Number ..~ ~/~. ~ ~~~.~.~.~...~...~~.~w~.~.~..~ Z.~.~.~~ ~ ~ Mumcipality 2 State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction: a Exist,ng use and ~cupancy ........ .~..~~.....~. ........................................................................ b In,ended use and occupancy ..... ~.~.~ ..... ~ ~.~..... ~....~ ~.a ~ ~. .................................... 3. Nature of work (check which applicable): New Budding .................. Addition ................. Alteration ................. Rej?air_. ................... Removal ............... ~.,.. Demolition .................... Other Work (Descr,be) 4 ~stlmatea ~os~ ............................ ~r.....~.~....ree ......................................................................................... (to be paid on filing th~s apphcation) 5 If dwelhng, number of dwelhng umts ...... h....; ............... Number of dwelling umts on each floor .... ; ..... :. ............... 'If garage, number of cars ........... ../.~:~ .................................................................................................................... 6. If business, commerc,al or mixed occupancy, specify nature and extent of each type of use ...... ::..,....'. ................ 7 Dimens,ons of existing structures, ~f any. Front ...; ...................... Rear .......................... '~ ~ ~ Depth ....~..:.~...~ .............. Height ...... '/.Zf...(-¢../ ............. Number of Stories ..........--~ ................................................................................................ 6" D~menslons of same structure w~th alterations or additions: Front ........ r~..~¢....~. .......... Rear ....c.,~..~ ................... ! t Depth ........ ..~.....~.'...' .......... Height ...... ................Number of Stories ........../. ........................... ii~! ~.~..7!i ...... .¢2.~..~..../· .......... Depth .:.~..'..?.. ~ 8 D~mensions of enbre new construction' Front Rear .............. Height ....... ./...~..: ............ Number of Stories 9. Size of lot. Front ...... ¢~.../~', ......... Rear ..... .Y..~....~..'~, ........ Depth ..Z.~.. ..... ./flY..17 .......... 10. Date of Purchase ....-~..~..~,.....~.~../..~.~..~ ................... Name of Former Owner ....Qm~.fF~.-.-.~..Z~..~..~....R..~.~6/.e..,?..~...~.,~ 11 Zone or use district m which premises are situated ...... ../~..~...~.l..~..~T..:.v...-Z.(...,Z~..~, ...................................................... 12 Does proposed construction viz9,Jate any ~9~lng law, ordinance or,; ,o~regulati°n~ ....... ~...o. ....................................... 13. Nome of Owner of premises .ff/f..AZ/..~'...~...L....6.../.'Z'...;'Z..~TP....'Z'.rf/J. Address ...-~.~./t/z~.+...,??..~-.-f..../~..:..~..'.~.~..~'...~fi:../df~hone No.~:...~,...~.%~...~... Name of Architect .................... .-TT......T. ......................... Address .......... .-. ................................ Phone No .................... ontractor ~ Ad ress ~' _ ~2) Name of C .~¢~[ii~ _~¢:tt¢/¢ ........................ d J' 'Z ~'~ I' 1['~ I ':~1~[~ Phone No.~....~/.:..~..~.~.c. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fron property hnes G~ve street and block numbers or description according to deed, and show street names and ind~cat, whether ~ntenor or corner lot. STATE OF S.S. COUNTY ..q, ttOR£ ............. being duly sworn, deposes and says that he is the applican (Name $igmng apphcation) ' / ] ~' '~ above named ~/e. s the ...... ? .......... C,..¢f~.....~ ~--~*,~ ............. (Contractor, agen~rate offic~' of sa~d owner or owners, end is duly authorized to perform or have perfor~ied th~ sa~d wo/,~ end ,&o make end fil. th~s application, that oll statements contained in this ap. plicabon are tru~ to th~' best of/his knQgdedge and behef and that the work wdl be performed in the manner set forth in the appl)/catiory f/i4ed th, erCvith. / Sworn to before me this /I ,/ Notary Pubhc,, .......................... ........................................................... day of ............................................ ,19County ........ "''~'"'~'~ ...........................