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Home My WebLink About3235-zFOEI~I 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P.E:RTIFIBATE: DF I::::iCC:LIPANCY , No. Z. 26~7.0Z... Date .............. ~h.. THIS CERTIFIES that the building located at . ~/~ .~ .~. A~ ...... S~reet Map No .... ~ ...... Block No.. ~ ...... Lot No. ~ ..... ~O~. ] ~, ........ coBforms substantially to the Application for Building Permit here/olore filed ~ this office dated .......... ~t ..... ~.., 19.~ pursuant to whi~ Building Pe~it No..~]~. dated ......... ~Sp~ .... ~ .... 19..6~ was issued, and co~orms to all of the require- ments of the applicable provisions of the law. The .occupancy 5or which this ce~icate is issued is .. PViV~. OAS -f~it~ · ~tt~g ........................................ The ce~icate is issued l.o ...~ph .~e~ .......... ~ev ..................... (owner, lessee or tenant) of the ~oresaid building. Suffolk County Department of Health Approval ... . ./ .... ........ TOWN OF -~OUTHOLD BUILDING D~I~RTMENT TOWN CLERK'S OFFICE 'SOOYHOi'D, Il. Y. BUILDIIIG PERMIT (THIS PERMIT MUST,BE KEPT ON THE PREMISES UN'~IL FULL COMPLETION OF THE WORK AUTHORIZED) Z Permission is'hereby grar~t~ed ~o: ................................ '. ................. ~m~,t ~,1,~,.... II~'Z.~ .......................................................................... ............................................................................ _' ............................................... ""~ ................. ,'Z ............. p~rsuant to appliCation dated ....................... :.:~tl:t/~..,.a~k.., 19.....~ and approved by the Building Inspector. S-9 $CHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. WHOM Ir MAY CONCERN: The sewage disposal facilities for a structure located (Give deed ~location)- ? ~,ve Deea inspected by this department and found to be satisfactory District Eng{neer FOEM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ....... Approved ........................................ , 19 ........ Permit No..........''......................~ ~ D~sapgroved a/c ..... ~.. ............................... .............................. Application No. ~'~ '~ ~ ;~' APPLICATION FOR BUILDING PERMIT Date .C~,'.T~.:..~../.~. ....... ...c~.....~.. ........................ 19...~....~.... 1NSTRUCTIONS a. This application must be completely filled in by typewriter or m ink and submitted in duplicate to the Buddin, Inspector. b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets o areas, and g~wng a detailed description of layout of propertymust be drawn on the d~agram 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. Sucl 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 m part For any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department far the issuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or alterahons, or for removal or demolition, as hereto descnbec The apphcant agrees to comply with all applicable laws, ordm~uildmg code and,~egulations. (Signature of applicant, or~ame, if a corporation) _ CAddress of oppl~l~,) // Name of owner of pre~~ ~..~~/~ ...................................................................................... ......... .................... 1. Location of land on which proposed work will be done. Map No' . ...........................................Lot No: ............... Street and Number ................................................................................................................................................ Mumcipality State existing use and occupancy of P. re~ es and~ intended use and occupancy of proposed construction: a Existing use and occupancy ........................... ~//~; ................. .~. ........................................................................... 3 Nature of work (check which apphcable). New Budding .................. Add~hon .................. Alteration ................ Repmr .................... Removal .................... Demohtion .................... Other Work (Describe) .................................... 4 Est,mated Cost ...... ~..p~'..~. G~-...~.. ................................. Fee ........................................................................................ (to be paid on fding 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 ar mixed occupancy, specify nature an8 extent of each type of use .............................. 7. D~mensions of ex~sting structures, ~f any: Front /,_.f¢/,2-~' Rear Depth Height ........................... Number of Stories ............................................................................................................. D~mensJons of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. He,ght .............................. Number of Stories 8 D,mensions of ~t~ec~z) new construct,on' Front'"" ../~"~'''""/~':'~f' ......... Rear ...... .k~...~.. ........... Depth ......~....~...~...%?.?.... Height ............................ Number of Stories .................... 9 Size of lot: Front ....... . .~..~..~. .......... Rear .......... f....~....~.. ....... Depth ............ ./.' .~.~.. ......... 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 11 Zone or use d~strict in which premises are s~tuated ............................................................................................... 12 Does proposed construction violate any zomng law, ordinance or regulation? ......... .~.]~. ................................... 13 Nome of Owner of prem,se~Z/-~ .~/.~.~.....~.~.:.~.~...Address ............................................ Phone No ................... Name of Architect ...................................................... Address ............................... ~,~ .......... Phone No ................... Name of Contractor~.~...~...~.....2('~..~.. .......~...¢....Addres§ ...~C~-~.~4~...y.~,.,~. ..... I~hone No.~..'f ...... ? ........ PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions fro property hnes Give street and block numbers or description according to deed, and show street names and ind~ca whether interior or corner lot. STATE OF NEW~RK~ _ Lw' .'~[ S.S. COUNTY OF .~...~..~..~..A...z...~. ..~~.~. ...... Z~-~ ............................................... be,rig duly sworn, deposes and says that he is the app/i (Name of indiwdual~nmg apphcation) . above named. He is the ........ d~~ ...... ~~ ...................................................................................... (Contractor, agent, co,orate officer, etc.) of said owner or owners, ond is duly authorized to perform or have performed the said work and to make and th~s apphcation; that all statements contained m this application are true to the best of his knowledge and b= and that the work will be performed in the manner set forth ~n~e apphcation filed therewi~. Sworn to before me this - ~ ~ ~ ~ ~ /' .............. o, ..... ...................... . NoraW Pubhc,. ........... ~Z:,~.,,~g..~...e~q~,}~. -""X~~~~;~ ' '