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Home My WebLink About3025-zFORM ~0. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. nEI~.TIFIEATE QF OOOUPANr. Y No..~..26~][ .... Date ............... .~..O.~.,...],0 .......19.6.6 THIS cERTIFIES that the building located at .t~./~... $~ll~g .g-3~:l~0~..,R~ ..... Street C~eaves Pt see II Map No ............. Block No ............. Lot No..3.6~ .... .~r~.enp~art, .N.,.~ ~ ....... conforms substantially to the Applicati, on for Building Permit heretof, o~e filed in this office dated ............... l.{~l?.~ll.. ~t9.6.6 pursuant to which Building Permit No. -302[. g dated ............ $][a~7¢11 .... 22 19..66 was issued, and conforms to all of the require- ments .of the .applicable provisi.ons of the law. The .occupancy for which this certificate is issued is., ?~.tva~;e..olae..fal~ll],~ · ~wo].-~.illg ......................................... The certificate is issued to ~.I?.~..nl.0.~...K.O..i1.~. ........ .0~.~.0~. ............................. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval .... I~'0.~.~..~.~. ~L966... b~.. R.,..V&lla .... ..... - Building Inspector TOW~ OF SOUTHO~D BUILDING DEPARTMENT TOWN CLERK'S OFF~CE SOUTHOLD, N. BUILD.tNG PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3025 z Date ........................ J{~.. (~¢~ ....... ;~ ............ , 10.66.. Permission is hereby granted to: .............. G~r~hog~e ............................................ ~t premises located at ..~,~..~.6.F..(].:Lo, a~e$...~o.i.~,..~e~....~.[ .................. ~ ......... , ............... ~.,..:... ............................... ,~g...~.~ ... , ....... p .. )... ............. ............ ...................... pursuant to application dated ............................. ~.~O~....~ ........... 19..~, dnd aPproVed by'the' Building Inspector ~ Fee $~0,.~0 ........... Ruildin~ ~n~ec*or' ,: . S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit No. ~L~O~)~'~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ~ - ' ~(Oi~e deed location) ~ have been inspected by this department and found to be satisfactory. - D,~ ~ [, ~I{~,t {~j~e~n g in e er FOI/M NO. 1 TOWN OF $OUTHOLD BUILDING DEPART/vtENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ..... Approved ........................................ , 19 ..... Permit No ............................ Disapproved o/c ....... ~~ ........................ ........................ ........................................... ................. .......................... (Building Ir~pector) ............ Application No. '~ o ~L-,~-' APPLICATION FOR BUILDING PERMIT Date ............................................................ , ]9 ............ 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 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 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. .......................... .............. 'f/ ....... Name of owner of premises ........................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1~ Location of land on which proposed work ~vill,be done. Ma~ No: ~.~..~....~.~.~.~.. Lot No: ....~..~.. .......... Street and Number ............ ~ ........ '....~...~...'. .............. ~.....~ ..................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .............................. i""~ ............................................................................ b. intended use and occupancy ........................... ~. .............. .(~ ............................................................................ 3. Na ute of work (check which applicable): New Building ~ Addition Alteration Re air .................... Removal .................... Demolition .................... Other Work (Describe) ....................... ~ ............... 4. Esti mated Cost ................ r~...~.l.~ ............................ Fee (to be paid on filing this application) 5. If welling, nu,mber of dwelling units .......... .~. ............... Number of dwelling units on each floor ~ if arage, number of cars ............................................................................................................................ i .............. 6. If ~usiness, commercial or mixed occupancy, specify, nature and extent of each type of use 7. Dir ensions of existing structures, if any: Front .......................... Rear .......................... Depth ............. i .............. Hei ;hr ............................ Number of Stories ................................................................................................ 4 .............. Din ensions of same structure with alterations or additions: Front ................................ Rear ................. i .............. DeF th .............................. Height .............................. Number of Stories ........................................ 8. Dir~ensions of entire new construction: Front ......... ~.~....~. ....... Rear ~..~/.. Depth .....~...~ Hei Iht ........... ~'. .............. Number of Stories ............................ 9. Size of lot: Front ........ Z..~q... ............. Rear .....(.q.Z,.:.~/. ........... Depth ............... ./...~..s...~. ........ t0. Dar of Purchase ........................................................ Name of Former Owner ........... '..~.. ........................................ 11. Zor~e or use district in which premises are situated 12. Do~s r ~ ,~ p oposed constructiqn violate any zoning law, ordinance or regulation ............... ! ....................... i .............. 13. No,ne of Owner of premises /~//'/~'.~ ................. Address ../~...~~...:.~hone No ....... ! .............. Nor[ne of Architect ........... ~.,q ......... Address ................................ ; ..... Phone No .......] ........... Nadne' of Contractor ...~. ~ Address Phone No. I PLOT DIAGRAM kocatb clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lihes. Give street and block numbers or description according to deed, and show street names andi indicate whether in}erior or corner lot. STATE OF COUNTY above nam of sakJ owr this applic~ and that fie work will be performed in the manner set forth in the application filed therewith. Sworn to b, ~fq~frne this .......... ..~..~.'~ ....... day of .., ........ ~~.., 19~.. .... NEWY~R~/ ~/~,2 / SS lome of in(JJvidual signing applicoti n) /Q7 -~//~] i d. He s the .............. ,z,...-~..~:,/. ........................................................ : (Contractor, agent, corporate officer, otc.) I er or owners, and is duly authorized to perform or have performed the said work end to make and file tion; that all statements contained in this application are true to the best of his knowledge and belief;