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Home My WebLink About3016-z'TOWN OF SOUTHOLD I~UILDII~IG DEPARTMENT 'I'OW~I CLERK'S OFFICE SOUTHOLD. l~l. Y, OEi~TIF'~OATE 0~' OOOUPANOY ~o.. Z. 2k:~.9... Date ................. ,T.u~e...9 ...... , ~6.6.. THIS CERTIFIES that the building located at .N/~.. I~eeD .}Io~e. ]~,.v.o .... Street Map No..Y,~,~ ....... Block No...:?~ ....... Lot No..Y,,~ .... Ma.l;t;~..t;ll~k~. I~,¥~ ....... conforms substantially to the Applicati,on for Building Permit heretof.~re filed in this office dated ............. ~93~¢~1 .],~.., 196.6. pursuant to which Building Permit No. 3Q~..~. dated ............... .~a.,r.~.~.],.~ 19.6.~., was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .occupancy for which this certificate is issued is ...P~..i.~.a..~.e..q)~e.. :~.~t~..l..q~,y..d.~.~,~.],~.~g .......................................... The certificate is issued ~o ... JOh~q .~a~bo~; ........... 0wrlo~* ......................... (owner, lessee or tenant) of the aforesaid building. ~Suffo]k County Department of Health Approval .. Building Inspector F01~ NO. ~ 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) No. 3016 z Permission is hereby granted to: pursuont to opphcobon doted ......................... Building Inspector , : ; ; . SUFFOLK CX)UN~f DEPA~TMENT OF HEALTH Date Permit No,, TO WHOM IT MAY CONUE}~: The sewage disposal facilities for a structure located at (Give de~d location) ' " have been inspected by this Department and found to be satisfactory. Dis~Fict ]~ngine e~ ~' Distric"t Enginee~ ...... FORM NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c ..... ~......~ ...... (Building Inspector) J Application No ............................. APPLICATION FOR BUILDING PERMIT Date .'~.~..~..{Z~..~.,~..~...../..:J.~.. ......................... , 19...~.~..~... 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 ad]oinin~ premises or public streets or areas, and giving a detailed description of layout of propertymust 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 Deportment 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 Lows, 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 regulations. ..... ................................. (Signature of applicant, or nome, if a corpora¢ion) (Address of applicant) ~ -- State whether applicant is owner, lessee, agent, architect, e, ngineer, general contractor, electrician, plumber o~ Name of owner of premises .~..?..../:f:../c~ ~z~.~/A~. ~ Z- If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of tond on which proposed work will be done. Map No:Ux~'~.c'.....~.~..z..~..k..~'..~.~.c..~-~.?..~..?~.~Lot No: ..f..... ........... Street and Number ............................... ; .............................................. ~, ................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ...... ...,~...L!(.~.~. ........................................................................................................... 4. 5. 6. Re~air ....................ova .................... Demolition .................... Other Work (Describe) ..................................... j (to be paid on filing this application) cJwelling, number of dwelling units ......... /.. ................ Number of dwelling units on each floor ........................... if If ~arage, number of cars If Dir He Dir Din' Hei SiT, Da~ Tot DoJs proposed construction violate any zoning law, ordinance or regulation? .. ~/~...¢. ............................. Na PLOT DIAGRAM e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensigns from nes. Give street and block numbers or description according to deed, and show street names and indicate ~'erior or corner lot. 10. 11. 12. 13. property whether usiness, commercial or mixed occupancy, specify nature and extent of each type of use ................................ ensions of existing structures, if any: Front .......................... Rear .......................... Depth .............. , .............. iht ............................ Number of Stories .............................................................................................................. ensions of same structure with alterations or additions: Front ................................Rear .................. , .............. !h .............................. Height ............................... Number of Stories ........................................ ensions of entire new construction: Pront ...~.~ ................. Rear ...~..9 ................... Depth ...q~..~... .................. ~ht ........ ../.~.. ............ Number of Stories ...~ ................. e of Purchase ........................................................ Name of Former Owner ....................................................... e or use district in which premises are s tuated ................................................................................... , ............ STATE OF COUNTY ( above non' of said ow this appiic and that Sworn to Notary Pul )NFEW~ S.S. ~'<.~......~~ .................................. being duly sworn, deposes and says that he is the ~pplicant qame of individ/~c~signin~J application) ~__~.~. ~ ~4 lle s the ~~.~~~ ~' ~ ................ "~'" (Contractor, agent, corporate officer, etc.) ~er or owners, and is duly authorized td perform or have performed the said work and to make Jand file ~t on; that al statements contained in this application are true to the best of h s knowledge an~ be ef' ~e work will be performed in the manner set forth in the application filed therewith. J ' ~fore me this ~ ~ , / ~- ~ / ~day~f ......... ~.~.~....., 19~~ ,~_fZ. -- ~ il. ~.fl ........ .... ..... ,dc, ..~~.~~... ~ug~' ~ ~ (Signature at a~l~a~} rqo 52-u3,i4963. Suflolk County ,_.~ / ~ [,~,,, ,ss:r,a Expires []arch 30, 19¢1 ................................................................................................................. i .: '...: ;,":'..-- ", ' ',':' ,",/,;,4. %,~:~/,4...c-c - ~/4/ = ILo" { r O: r NO; Io'o [ ]£L,4-" ! [ ,7¸ 4 6, L4~" o~ 0 PLAN NO;