The URL can be used to link to this page

Home My WebLink About3111-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. OEETIFICATE QF nooUPANOY No. ~. '2~C~ .... Date ............... THIS CERTIFIES that the building located at . ?.?~.h..a.~l.~.e...~.~. ............... Street Map No..3~'~ ....... Block No~ ......... Lot No. ~ .... [~Ott~;.hO~C~.i. ~]f.~. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~a~'. · · · .~.~.., 19. ~0 puts u'ant to which Building Permit No. ~.~..~. ~.. dated ............. ~tl31e.. ~l..-, 19~f~., 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~,~va0~e. O~' ~c~'.':,~:].y '/i~J i~..~:,n~ .......................................... The certificate is issued t,o . .~:,fa.X.~el~..~?[-~[t.:I.~lS ........ 0W~eZ' ......... , .............. (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ...... ~{ ,'~.~. ............................. Building Inspector FOI~M NO. 2 TOWN OF SOU~I'HOLD BUILDING D~:PARTMENT TOWN CLERK'S OFF]CE SOUTHOLD, N. Y. N? BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3Jll Permission is hereby granted to: ............ Sou~hola.i .................. ~ ................ i ......... to . .]~L~.i~ .. ~,..a~.~i.%.~en.. on...a~-, e~ f~i~'' ~,'~e ~ -~ f~ ........................................................ at premises located at .;.~;/~'""]~4ee~a~:~'-'~q~ ............ : ...................................................................... ................................ ............ :... ,~e~-.~o.l~.~......~ .~ u ..,- .......................................................................... pursuant to application-doted ............................ ~j,~ ....... ~'8 .............. 19..66.., and approved by the Building Inspector Fee $"~'~'00 ............ Building InspectorI FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved~' ~'~ 19...~... Permit No. c~ 1 ~ (Building Inspector) ( APPLICATION FOR BUILDING PERMIT Dote ....................... ,.,m..~ ........ ................. , .... 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 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. c. 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or f~egulations, 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) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ..... ~.o..~.~c,~..,'.~ ................................................................................................................................................. Name of owner of premises ........ ,~(,~,/~,,~,~-~,, ........... .,,~,,I,,L,/,~.,J.lZ~,Jzl~,~. ....................................................................... If applicant is a corporate, signgture of duly authorized officer. ~ame and title of corporate officer) 1, Location of land on which proposed work will be done. ,Map No,: ........................................ Lot No,: ........................ ' Street and Number ......... ~ ........ r ...... :......~ ....... .~.~ ....................... Munici~lity 2. State existing use and occupancy of premises and intended use and occupancy of propos~ construction: ~. E~ti,g ,~e ~.d occ,p~-cy ......... .~.~.l.~/.~C.~ ........................................................................................ b. intended use and occupancy ................. ~.~.~..: .............. : ........ : ........ : ......................................................... 5. If d, If ge 6. If 7. Dim Hei! Dirt Dep 8. Din' Hei~ 9. Size 10. 11. 12.- 13. Nar Nar property Ii whether in erior or corner lot. ::ti of Work (check which applicable): New Building '. Addition .................. Removal .................. Demolition .................. Other Work (Describe) (to be paid on filing this applicat~a) ceiling, number of dwelling units ............................ Number of dwelling units on each floor .. rage, number of cars ~siness, commercial or mixed occupancy, specify nature and extent of each type of use ;nsions of existing structures, if any: Front ........ .~..~. .............. Rear ........ ~.~ .................. Depth .....~. ......... ht ....... /.~.../. ......... Number of Stories ,nsions of same structure with alterations or additions: Front ........ ?....~.. ...... '. .............. Rear ........ Iht .................... Number of Stories Dar of Purchase ..... ~,~.~(~Z~.~.~,~....-:: .................. Name of Former Owner Zone or use district in which premises are situated Doe proposed-construcfion violate any zoning law, ordinance or regulation? ...~..q..~ .......... ~e of Architect ...................................................... Address ............................................ Phone No. PLOT DIAGRAM Locat,~ clearly and distinctly oil buildings whether existing or proposed, and indicate oil set-back dimensions nes. Give street and block number or description according to deed, and show street names and: ,I, STATE OF COUNTY NEW YORK, ...... ~.:~..~..~ (~....~..~. ......... ~,~,~4~,~,~.,~,~.~,i..,: ..................... being duly'sworn, deposes and soys that he is the applk (Name of individual signing application) obowi na,r ~ed. He is the ........~.-.O../.~.Z'~.~.¢~...,~. ......................................................................................................... (Contractor, agent, corporate officer, etc.). of said ortner or owners, and is duly authorized to perform or have performed the said work and to make and this appli~alion; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ ~rk will be performed in the manner set forth in the application filed therewith. Sworn to k ~.fore me this "~ ......... J,..~ ..... d~y of ........ /,r/..-rl~-~'~.....~ .............. , 19..~..I~, ' .-'~. 'M' ~ ' (Signature of applicant) Notary P~ :~lic,--~C"~'~aq"'""~":'" CountY~A~10N ,, : ('/ NOTARY pUBLIC, State o[ ~'~ew Yolk Plo, 52-3233t20 St~ffolk County, Term Expires ~arcl~ 30, 19~ 7