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Home My WebLink About2970-zFORM I~0. 4 TOW~ OF SOUTHOLD BUILDING DEPARTMENT TO~'~ CLERK'S OFFICE SOUTHOLD, N.Y. E]ERTIFII~ATI~' OF O00UPANr!.¥ No. Z. 2~06 .... Date .................. Au§~az~; .1;L.., 19.66. THIS CERTIFIES that the building located at E./.~. }4aL~..P,,.~a,~ ........... Street Map No. ~ ....... Block No. Y~ ........ Lot No. ~... ~%~:k.i'~ok~, .~.~ ...... conforms substantially ~o the Applicati~on for Building Permit heretofore filed in this office dated .......... ~8.l~l&~*.. ~.., 19.~. pu.rsuant to whleh Building Permit No..2~0.Z. dated ............ ~a~..~., 19~., was issued, and conforms to all of the require- ments ,of the applicable provisions of the Iaw. The .occupancy 2or which this certificate is issued is .~a.~.. O~e, ~m~.~'. ~li~..(p~O~g~) ........................... The certificate is issued bo . ~D~.~OP.~. ~.~. .... Q~LQ~ ........................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health App,,oval .. ~g%. ~..~. ~. ~, .Ir,~,~&... ~ *~ ,,,~,-.._...__ _~ ~ ........ ......... FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y~ BUILDING PEP. MIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2970 z Permission is hereby granted to: · .~ese.~a.. 9~"'"~(]'""]~]~['~o~];'"~.OeeSe · .................. ~.~ e~ql~s'z'*~. ........... : ........................... to ... B~?z.]:&..n~?~ -.o~e ."r ~±'~Y" v~'¥~?c~ ~ ~; , ~ ............... · ct premises located at ~.[a~,~r.!.8...l~d.-~.-.~ ........................................................................ ............................ ~:t, ue~ ........ ~:,.~.~ ....................... :' ............ : ........................ : .... .................................................. .........." :, : 7','/'"?"'." '~ ~?.' ' "?;~'~ .......... ? '" '? '~ ; ' pursuant to ap[~JJcatJon dated'. .......j~.:..:~.i....j..:....,y~:....~.:~.:~....,,..; i9.~;,; arid 'a~pioved by the .. ' :; Building Inspector Fee $ ........ NOx~'~ ...... FOR~I ~0. 4 TOWN OF' SOUTHOLD BUILDING DEPARTMENT 'I'OWI~' CLERK'S OFFICE SOUTHOLD. N. ¥. TEMPORARY I~IrI~TIFII~.ATI[ rIF rlP. I~.UPANP. y THIS CERTIFIES that the building located at ... Ig?~...lia~2y.~.~. l~OaCl ...... Street Map No..X,=,&~;X. ..... Block No..XY..X~ ...... Lot No. XX ..... lqla?atJ, tll~k~ .I~.]~, ........ conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ............. Jarls...3 .... 1966. ~pursuant to which Building Permit No. 2.~.0. 7.. dated .......... i,..,T~t...~ .... 19.~,;-.was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .occupancy ~or which this certificate is The certificate is issued t.o .l~pJ,~o.apa]~,.D~o¢.ass ............... 0wr~el'... ............. : ' (owner, lessee or tenant) of the afore.said ~,pilding. .Suffolk County Department of Health Approval ......................................... Building Inspector s-9 SUFFOLK COUNTY DEPAHTMENT OF HEALTH Date TO WHOM IT MAY CONCERN: The sewage disposal facilities for a str~cture located at / / :,; ? -,- have been inspected by this Department and found to be satisfactory. District Engineer ,.,~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Exam,ned ...... .......... Approved ........................................ , ............................ Disapproved a/c~ ~......~... Application No. ~ ....................... ......................... ff"iA"' ( 'd' g mspec~ii: ............................... APPLICATION FOR BUILDING PERMIT 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 pa.rt 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 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 laws, ordinances, building code and regulations. Jo.8 e.,q.h .D...:],..a. ~ .............................................................. (Signature of applicant, or name, if a corporation) ......... G~.e.er~por.t, E, ~., ................................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. .................................................. Can.~.a~ :~ o.~. ....................................................................................................................... Name of owner of premises ..... .~.~.~.g.O.]g.8,~...~.~-.~.~.¢..8 ...................................................................................................... If applicant is a corporate, signature of duly authorized officer. (N~me and tide of corporate officer) 1. Location of land on which proposed work will be done..Map No.: ............. ~ ................ ~.. Lot No.: ..~ ............... Street and Number .~n~.Ls..~.a~.~ ............. ~&~c~ ..................................................................................... Munici~lity 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 ~cupancy ...~..I.~1~..~ ~.~&~ ................................................................................ 3. Nature of work (check which applicable): New Building ..... ;~Z2~;... Addition .................. Alteration .................. Repair .................. Removal ..................Demolition .................. Other Work (DescriBe) ........................................ 4. Estimated Cost ...... ~.~.t2..C)0 ........................................ Fee ......... ~.f}~ ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ........ .Q~9., ............. Number of dwelling units on each floor ............................ If garage, number of cars ...... ~..~. .......................................................................................................................... 6. If business, comme~ial 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 Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ B. Dimensions of entire new construction: Front ........ L.~.~ .................... Rear ............ ~.Q ........... Depth ...... Height .................... Number of Stories ~ .................................. ~. Size of lot: Front ....... Rear ~.~Z..~.~P ................. Depth ..... 10. Date of Purchase ......... ~.~ ..................................... Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated uAu 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. ~ .... . ........... 13. Name of Owner of premises ...~.~$.~.Q~.~..~$9.q~.~dress ............................................ Phone No ..................... Name of Architect ..... ~.r....~.~.gP. ........................ Address ............... ~O~¢.............................3~ e~O~ Phone No ..................... Name of Contractor ...~....~z ................................ Address ........ ~.~).~. .............. Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buffdings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether i.nterior or corner lot. STATE OF NEW_YORK, ~ c c COUNTY OF ...[~.~.~][ ........... ................................ ~.~..~.$~. ...................................... being duly sworn, deposes~and says that he is the applicant (Name of individual signing application) above named. He is the ................. ~.O~g~.~O.~O~. .... (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 file this application; that all statements conta:Jned in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth n the appl2cat on filed therewith Sworn to before me this /'/ ' ................... ............. .............. , r P ......... ~..d....~..~ ......... 7 ...................... NOTARY pU~C, Stato o[ Row Yo k No. 52-323~0 SLm~H{ Oo~mty, Term Expires Mamh 30, 19~