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Home My WebLink About3116-zFOEM i~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFI~.AT£ 12F E]CCi. I~ANCY No. Z '267~ .... Date ............... 'ttI~ril' · '10 .....19.67 THIS CERTIFIES that the building located at . .E/.~I. I{o:V~;hf~old..Dt'. ...... Street Map Bio..XXX ....... Block No ..... .~ .... Lot No. 'X:;~ ....... Southold~' 'Nv~ .... coniorms substantially to the Application for Building Permit heretof~re filed in this office dated ........ ..... ~l'~3a'l~' (~li' ~)(~t~ .... pu.rsuant to which Building Permit No. dated ........... ~...~ ...... 19.6t5, was issued, and conforms to all of the require- me.nts ,of the applicable provisl.ons of the law. The .occupancy ior which this ce.rtifieate is £ issued is . .P?.l.¥.~.~.e...O. IL~... i1,It1~7..~l~.ollillg .......................................... The certificate is issued 'vo .... ~,lgd.wat~l. Ool, lovs~- ...... o}rglo~ ..................... (owner, lessee or tenaht) of the aforesaid building. Suffolk County Department of Health Approval ......... I~' ',~R' .......................... Building Inspector '~ FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL[P,K'S OFFICE SOUTHOLD,, H. Y. BUILDING PEP, MiT (THIS PERMIT MUST BE KEPT ON THE ?REMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3116 z Permission is hereby granted to: ......... .~ .O..~L ;~i.b. ?.~. ~..'~ .......................... .......... : pursuant to application dated ................... ;g~..t~,..,f/..C......Z]. ............... 19{~.(~.., and approved by the Building Inspector Fee $:; ...................... · ~ ................ i~uilding Inspector FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. Application No. ~ ']' / ~ APPLICATION FOR BUILDING PERMIT Date ........................... .J..?...:..A~.....L:.~...., .(q....., 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 applicJation. c. The work co~ered 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 H.EP, EBY 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 comp y with all appl cable laws, ordinances; bui ding code and regular ans. (Signature of applicant, or name, if a corporation) (Address of a~i~)''T ........................ State whether applicant is owner, lessee, agent, architect, engi.neer, general-contractor, electrician, plumber or builder. 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 will be done. Map No.: ~/~ ~'~" Lot No.: ......~.....~...i ........ Street and Number ...... ...~...0..~.?....~.......~-~.....~'....~....~.. ...... ~..~..:.....'.........~.....0.....~.....T~.../~....~...~.....~.. ................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ..~,..,....~......~::.~...~....L~..,k....../~.,,,C?,. ..................................................................................... b. Intended use and occupancy .~. ~ f...D~. ~...'~. C.~ t ~ ('1, .~. ~ ~) A]' - 3. Nat ~re of work (check which applicable): New Building .................. Addition ....~,.~ ..... Alteration Rep/dr .................. Removal .................. Demolition .................. Other Work (Describe) aoZ- 4. Esti~ated Cost ............................................................ Fee (to be paid on filing this application) 5. If d~velling, number of dwelling units ...... ~ ....... NumBer of dwelling units on each floor If g,~rage, number of cars 6. If Lusiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dirt ensions of existing structures, Jf any: Front ............................ Rear ................................ Depth Hei!lht ........................ Number of Stories Dimbnsions of same structure with alterations or additions: Front ....................................Rear Depih ................................ Height ............................ Number of Stories ................................ t~~ 8. Dirrensions of entire new construction: Front ............. ..~...~ ................ Rear .......~. ................... Dep Hei~jht .................... Number of Stories / 9. Size,' of lot: Front ............................ Rear .................................... Depth ................................ 10. Dat~e/ of Purchase ....................................................... bNamue of 11. Zon:e or use district in which premises are situated ..... i~ .......... 12. Doe,si proposed construction violate any zoning law, ordinance or regulation? ........... "[ .... ~'~'/~) ~'~/'0VlZ~Address .~'..O. rJl~-~l~C-I~ . Phone 13. i'~o~e or uwner at premises ............................................................................. No. Name of Architect ...................................................... Address ............................................ Phone No. Nar~e' of Contractor ..... ' ~--'- ~ .~....~,,,.O.......~.....G~...~.~ .~...~/'.Address ......... .~....~....~....T.,.(~.~..tr:,..~ ...... Phone No. PLOT DIAGRAM l.ocat~e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property hnes. Give street and block number or description according to deed, and show street names and whether in' erior or corner lot. STATEO~NEWY~RI( , ~f i, SS ................. ! ........... ...t¢~..,..~...~......~.....~..~.. .( ............... being duly sworn, deposes and says that he is the applk !(Name of individual signing applic~i~,n)~ / (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this opplidation; that all statements contained in this application are true to the best of his knowledge and belief; that the wbrk will be performed in the manner set forth in the application filed therewith. Sword to b~efore me this Notary Public, .... County (Signature applicant) I Il MARION A. REGENT ~ ~ NOTARY PUBLIC, Stale of New York j No. 52-3233120 Suffolk County I Term Expires M.arch 30, tg~