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Home My WebLink About3021-zFOI~M ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OWN CLERK'S OFFICE SOUTHOLD, N. Y. Date ............... ~:-1 g~..2 ..........19.66. THIS_CF~TIFIES that the building located at ........... Cll~/ll~.l~l~..~v~,.. Street Map No ....... ~... Block No.. ~ ....... Lot No...%.6 ........... 6O~thald,..~. Y~rk conforms substantially to the Applicati~on for Building Permit hereto~e filed in this office dated ...... ] ....~ .$~ ..... 19.66. pursuant ~o whi~ Building Permit No.~021..~.. dated .......... ~. ~ ..... 19~.6., was issued, and conforms to all of the require- / ments Of the .applicable provisions of the law. The occupancy for which this certificate is issuedis........... · · .......................................... / Thi certificate is issuea t.o .~.~..B~. ~.~b.,..~eK ............................ / (owner, lessee or tenanO of the ~oresaid building. / ~ /~uffolk__ County Department of Health Approval ......................................... FOI~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. BUILDING P~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3021 z Permission is hereby granted to: William..B.....$~itk ................................................ ......... .s...o. ~ .o..!,:..! L..~ ,...t'i,. ........................ i ......... at premises located at lot 16~ Fairview Pa~k ' ; , :, ..................................................... ~/S Clearview Ave Building inspector Foe $~.~.~r ...... Buildin~ Inspector YOB~ 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTME~IT TOWi~' CLERK'S OFFICE SOUTHOLD, N, ¥. i~EETIFII~ATE rlF DEI~UPANEY No. ~. ~)-~.2~).,.. Date . .Ammenclecl .... S. ep'~..9 ....... , 1966. THIS CERTIFIES that tile building located at .. (J.],eO, l?V;[O~. A~re ............ Street Map No ............. Block No ............. Lot No. i1s ....... ~olltllO].d.~..i~.,.X', ........ conforms substantially l~o the Applicati,on for Building Permit heretof, o~e filed in this office dated ........ ~a:X:¢~... ~8 .... , 19~.~. pursuant to which Building Permit No..-~02~-.g dated ......... IvJa~.e,Y~ ..22 ..... 19.65, was issued, and conforms to all of the require- ments ,of the .applicable provisions of the /aw. The .occupancy for which this certificate is The certificate is issued to .. l~Yn~.,B.,$~itZi. A/U.. [gom. ,~avson ...... 0~me~. .......... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval .... Baa.i;..~.~..19~S~,...]r~,'..R~i~']..a ..... Building Inspector s-9 SUFFOLK COUNTY DEPARRI~ENT OF HEALTH Date Eldg. Permit TO WHoM IT MAY CONCE~: The sewage disposal facilities for a structure located at " ~ ' (Give dee~d location) have been inspected by this Department and found to be satisfactory. District 'Engineer TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am~ned ........ .~?m..,..~.~ ..... ~9........~ ~ Approved k 19.~.....Permit No. '~ 0 Application No. Disapproved a/c .............................................................................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............. ...................................... , 19 ............ INSTRUCTIONS a. 'Fhis application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. PJotplan 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 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 Department for the iss6ance 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, ording~ces, building code and regulations./2 ¢7 ........... (Signature~of applicant, or name, Jfa corporation) .............. C~ ......... (..X;i~.;;;;..;;F;.;,~;,~;;;.;t)......~/¢. .................. State whether applicant is owner, 19~see, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ......... .~...~.~ ...................................................................................................... .. If applicant is a corporate, signature of duly authorized officer.. (Name and title of corporate officer) o. o k · ~'~z_ //~.. ?r~/t _ 1. Location of land wh ch prop sad war wffl be done. Map No: ........................................... ,Lot No: .,Z, ~.. ........ ......... Street and Number .......................................................... ,~~ .................................... Municipality 2. State existing use and occupancy of pre,r~ses and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ,~....~.......~. ............................. : ..................................................... b. Intended use and occupancy .......... ~ ......................................................................... Rep~ 4. Estir 5. If d, If g, 6. If 7. Dim, Heic, Dim, Depl 8. Dim, Hei§ i NatL~re of work (check which applicable): New Building .................. Addition .................. Alteration ....., ............ ~r .................... Ramekin,, ,~ ,. ~ .~Z~ ..... Demolition ................. ~'/ ~ ~bOther Work (Describe) ..........................! ............ rated Cost .............. .r.,,/.....~2 ..,~/_ ,....c~.....~...,~-~ ......... Fee ' _./.....~.....~.... .......................................................... i ............ (to be paid on filing this appl.ication) veiling, number of dwelling units ........ ./.. ................ Number of dwelling units on each floor ............ irage, number of cars ............../... ............................................................................................................ , ............ ~siness, commercial or mixed occupancy, specify nature and extent of each type of use ................... L ............ !nsions of existing structures, if any: Front .....----~.....~.. ............ Rear ....~....~... ............. Depth .._~......~....: ............. ht ..... ~..~. ................ Number of Stories ........ /..... .................................................................................... ............ msions of same structure with alterations or aaditions:' Front ................................Rear ................... ii ............ .............................. Height ............................... blgmber, of Stories ........................................ ,sions of entire new construction: Front .................... : ....... Rear ............................ Depth ............... i ............ qt ............................ Number of Stories ............................ j 10. 11. Zorn 12. Doe, 13. Nar Nar Nar Locah property whether Sizelo' proposed construction violate any zor~n,g I~wJ/ordlnonce~r regulaJlon? ..... ~..~. ...................... ! ...... of Architect ...................................................... Address ................. .//. ....................... Phone No ..................... .................................................... Address ............................................ Phone No ........ : ............. te of Contractor ?/ ~/ A PLOT DIAGRAMIi . clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from Jes. Give street and block numbers or description according to deed, and show street names and Jindicate erior or corner lot. STATI--OF DNFEW YORK, / S.S. COUNTY, ' ................................ ................. J ............................................................................... being duly sworn, ,deposes and says that he is the pplicant (~ame of individual signing application) above nam'ed. He is the ........................................................................................................................................... i ............. . (Contractor, agent, corporate officer, etc.) of said ow~er or owners, and is duly authorized to perform or have performed the said work and to make land file this applic ]tion; that all statements contained in this application are t'rue to the best of his knowledge anti belief; and that ~ work will be performed in the manner set forth in tl}e application filed therewith. Sworn to ,fore me this__,,~,q /) 9...~... ,~ ,, ~, ,' ........ :~. ........ day of ...,..Y..(..~F/.~,~ .............. "-,,,~ ~ ' /z ~..~ _ ~ / ...... .~..":.~c:...~...".f..T..,~,.:....'~:..~:~ ............. .~......~~. ./... ............ Notary Put lic, .~.J,./~,w~c(,c~c/~.....t~...~..../.~County · (Signature of applicant) I [ I ~ARION A. I,[CET,]l I ] ~OI'ARY PUBLIC, St~te {,I [law Y v ~10. 52-3233120 Suffolk ~'erm Expires lvl.srch 30, l~.&'2