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Home My WebLink About3039-zFOI~VI ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. OEETIFIOATE OF OOOUPANOY No. Z..2~.~ .... Date ............... 0~tOl~e~'' ~0-', 19.~(~ THIS CERTIFIES that the building located at [~/~...1~1,~e. ']~,~e0~ 'l[~2d' ..... Street Map No..~1;~ ....... Block No .... ~ ..... Lot No.x.~X ..... ~Otl~;'hO'~.~l~' ~'~ ........ conforms substantially to the Applicati, on for Building Permit heretofore filed in this office dated ............ At~]~-l.]. .... ~., 19. ~6 pursuant to which Building Permit No. '~&~9' ~ dated ........... A]~l,i~l....~.., 19~., 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 .. P.~iv&te' ~1(~' f~'~i~.~ ' cl~t:~:ir~g ......................................... The certificate is issued t,o .. ',~kl~' ~l~,~;h .......... O~el' ............ ~'~[ ........... (owner, lessee or tena ) of the aforesaid building. ,Suffolk County Department of Health Approval ....... '1~;'"1~; .......................... ... ~.~c~j.~,,~...~ ......... :q .............. · Building Inspecttr BUILDING P[RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3039 Z Date ........................ April ........~ .............. , 19.66.. Permission is hereby granted to: ~ob'~.,...K'~:.a.t~.....A/0.....Ed~...~,j£~.~k ....................... ............ 8 o~,~;~ .I,~ ........................... : .................... to..b, uild...am..~dd&tion...o~ .. ~u..~;¢t.s .ting...d~e.l.~,i~g ........................................................ ct premises located at .~.i~Qe,.Ms,~}C..~;~a~ .......................................................................................... ........................................ ~.~.u f~hOld..... ~. :~ ...................................................................................... pursuant to application dated ................................. ~p~.~,l.....~ ........ ; 19..~., and approved by the Building Inspector Fee $..~,~O.Q ............ ........ f.L ~,,~., :.~, ...~. ........................ ~,~ ..................... ~ Building Inspector FOPvM /'~0. 1 TOWN OF SOUTHOLD BUI ~LDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ........ Permit No. ~'~ Application No ................. ~. .......... Disapprove~...~ _--- , ................. ...... ...................................... (Building Inspe~qr) AP~LICATION FOR BUILDING PI~RMIT J Date .......................... .~.~.r...J:.~ ............ ~ ....... , 19..~. 5. ...... 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 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. (Signature of applicant, or name, if a corporation) ............... ,~ o.ut~o[Ld .............................................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Contractor Name of owner of premises ....E.dw.....Wlr.tk ....................................................................................................................... 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. Map No.: ....L%~ ............................ Lot i<io~ ..................... Street and Number ...... ixl/.$L.../~.in.e...Ne.e-k...R~ad.~ .......... gg~t.b..old. ................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~.~elli~.: ......................................................................................................... b. Intended use and occupancy ..... .same wit. h ..a..d...d..i...t..i..0.D ......... 3. Na?re of work (check which applicable): New Building .................. Addition ...;:f~g¢, ....... Alteration ................... Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ Esti~nated Cost .....~.~O.....P~.~ ................................... Fee ....~.. .................................................................... ] .............. 4. J (to be paid on filing this application) 5. If d.,,welling, number of dwelling units ......0~. ............... Number of dwelling units on each floor .............. .............. If gprage, number of cars ............................................................................................................................................. 6. If ~usiness, commercial or mixed occupancy, spec!fy nature and extent of each type of use ............................ 7. Din:ensions of existing structures, if any: Front ............................ Rear ................................ Depth .......... I .......... J-lei ht Number of Stories Din ;nsions of same structure with alterations or ~dditions: Front .................................... Rear .............. .............. De th ................................ Height ............................ Number of Stories ................................ 8. Din ensions of entire new construction: Front ..... .~. ............................ Rear ................ ~. .......... Depth ..... .8...' .............. Hei ht .................... Number of Stories ...... ~Qe ......................................................................................... + ............. 9. Siz~ of lot: Front ............................ Rear .................................... Depth ................................ 10. Dath of Purchase ........................................................ Name of Former Owner .......................................... ' .............. 1 1. Zor~e or use distric~ in which premises are situated .......... .*T. .......... ff......Y. ....................................................... .............. 12. Doe~ proposed construction violate any zoning Iow, ordinance or regulation? ............... ~ ......................................... 13. Na,~e/of Owner of premises ..~.~l.l~.,...l/J.~.~]~" .............. Address ............. .~.0.~g.~..~' ........... Phone No .......: .............. Narhe of Architect ...................................................... Address ............................................ Phone No .......] .............. Name of Contractor ..]L:Lo...T-T~a,I:;.t ............................... Address ......... ~.OtZt,~g. ld ................ Phone No .......' .............. PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensiens from property lines. Give street and block number or description according to deed, and show street names andl indicate whether in~erior or corner lot. / STATE OF COUNTY NEW YORK, .................. j ............ ~.~.b.t.....~X,~t.'C.. ...................................... being duly sworn, deposes~ and says that he is the 0pplicant ! Name of individua signing application) ~ ' above non'ed. He is the Contractor (Contractor, agent, corporate officer, etc.) of said owger or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the wqrk will be performed in the manner set forth in the application filed therewith. Sworn to b~fore me this ................. ,d y of ............. .......... , _ -77 - pu,Jlic,/~ ./.~../~l~t~,~~ount~)Y~ '~ 2 /} ~f~ ~/'~,~,~, .... ~.....~'~-,~....¥...~.....'~...~~...~(Signature of a. pp.~ant) ................. Notary ¢ommissio~ JhplreS j~rcll 30,. t~l...(l~./ ,, . /