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Home My WebLink About3295-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL~RK'S OFFICE SOt~-t-~IOLD, N. Y. I:::E:RTIF'IOATE: O~' OOP. UPANCY No. ~31+:~}+ ..... Date .............. Eebura .. }+..., 19.69 THIS CERTIFL~S that the building located at RJS.. L~t~ .A~'~ ............. Street Map No..X~t ....... Block No. ~X ......... Lot No. 'X~" '~%t~t't~l~l~ .... N~'¥~ ........ conforms substantially tn the Application for Building Permit heretofore filed in this office dated ........... Oct'"~fl ..... , 19. ~ pm'suant to which Building Permit No.. ~29.~ ~ dated ........... {)et .... 3'1 ..... 19. '~6 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 .Pl'.$va.%e. olte..fa~ll~, .~t~e~.'2..ing .......................................... The certificate is issued t,o plied .&. 'DOl':~S ']~e~:f" '('o~e~,~e~'~;'t~i) ........... of the aforesaid building. Suffolk County Department of Health Approval Jail...31...1~9..-bF-.R,..V~t.l. la ....... Building Inspecto~ FORN[ 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? 3295 Z Permission is hereby granted to: ............ .F. l'.ed...I[elf.....&/¢ .... ~it ..Heir.. .... ..... -~:.....~ne..A~* ............................................. · "lq~'~'~tp'~ q~t"-P~t~qt-~" '~';'Y'; ........................... to ~llld ..new...one .. f~m~l.~.. ~wel/,~z~ ................................................................................... at premises located at ..R.~8.....~ra~,..:~.,;,e .......................................................................................... ................................. ~u~I~"~i';~'; .................................................................................................. pursuan,t to application dated ............................... O~tO'be'F'""~;", 19..~., and approved by the Building Inspector. Fee $.10.,00 ........... ..... t.~...:.. ..................................... : .................. Building Inspector / BUILDING DEPARTMENT ~(~X~."."~'~ ~ TOWN CLERK'S OFFICE .~%,~ ~/¢. ~ $OUTHOLD, N.Y. ~. X~'~.- '~'"'~' ,~ ~ '~ ~ * Examined .......................... · ......................... 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. (Signature at apl~cant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ......... ......................................................................................... .................... i ....... Name of owner of premises ....~).O.~.t~.....J~..~...~. ............................................................................................................... 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. Mop No.: ]~.~D..~.~...~...~.....~. ........ Lot No.: Street ~ and Number ...... J~ ~.i~l .'~..../g~.g.E. I%J .g. J~. ......................... .L.. I~g..L~.E.I~..t..T.Q~)Jg....O.~....~ ~ .~ ..T...~..g..~..~ ..... Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .~J.te~"/~../~..T...../.-,Q..T.. ........................................................................................... b. Intended use and occupancy ...C~..~...,.~J~c.~,.~..~..~.......J).U~.J~.~..L:.L..~..~.... .................................................... 3. Nature of work (check which applicable): New Building L..../... ........ Addition .................. Alteration .................. Repair .................. Removal .................. DemdlitJon.; ....... ..;..;;:; Other Work (Describe) ........................................ 4. Estimated Cost . . .?.OX:~.q ...................................... Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... ~...~..'~'........'....Number of dwelling units on each flor ............................ If garage, number of ~m ........ ~ ................ ~ ....................................................... 6. If business, commercial or mixed ~cupancy, speci~ nature and extent of each ~pe of use ............................ 7. Dimension,,of ~isting structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stori~ ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..~.~.~...~.~ ................. ear..~....~ ............D~th ......~.....~ ....... Height .................... Number of Stories ................ ~ ................................................................................................... 9. Size of lot: Fret ....... ............ Rear .../~.J..:..~0 ................ ~pth ~./~.~:~y..~ /0~ / 10. Date of Purchase ,~..~.~ ....................... N~e of Fo~er ~ner .~J~...~.~¥~.~.~.~. ...... 11. Zone or u~ district in which premises are situated ..................................................................................................... 12. ~s pr~osed construction violate any z~ing law, ordinance or regulation? ....... .~..Q ............................................. ~ ~ ~ue, 13. Name of ~ner of premises ....~P.~)~....~.~....Address ~.~.~.~.~.~ ..... P~ No.~.~L~.~.~ Name of Archit~t ...................................................... Address ............................................ P~ne No ..................... Name of Contractor .~.~.~.....~.~ ...................... Address~..~.~.~..~.~.~ .......... Phone No. ~[.~.~.~ ~s~u~ PLOT DIAG~M " p~e~ lin~, Giv~ sl~e and bilk num~ o~ d~Hption according to d~d, and s~ ~t~eet names and in~i~at~ C/M OFt~--Z.Z.. I STATE OF NEW YORK, ~ c ¢ COUNTY OF ................................ $ '~"~' ................................ · ~..~.~-.~).....tl~...~....~..~.. ........... ~ .................... being duly sworn, deposes end says t~t he is the applicant (Name of indivi~ol signi~ application) ab~ named. He is the .~o.~.~.~.Q.~ .............................................................................................................. (Contractor, agent, co~orate officer, etc.) of said ow~r or owners, and is duly authoriz~ to perfo~ or have performed t~ said work and to ~e and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Swam t0 before me this .... ............ , Nato Pubhc ~ ~' ............... ~~~~ ...................................... ~t~ ~lic, ~~.~.....~ .................. Coun~ (Signom~f applicant) S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date January ~!, !9~'9 Bldg. Permit No. 3?9~2 TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located N,20~6' W 100.~q' ~M ~ve. (Give deed location) Law re]., Sou th old have been inspected by this department and found to be satisfactory. District Engineer