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Home My WebLink About3119-zIvOI~M N~O. 4 TOWN OF SOUTHOLD RUtLDING DEPARTMENT 'I"OWI~ CLERK'50FFIC~- SOUTHOLD. N. I~ERTIFII~AT£ UP' Qor. UPANOY No.Z ~608 Date l~0VOlllbe~* )4- 19..6.6. THIS CERTIFIES that the building located at ~/~..~'~Oe.~WOO~.l~%d, ..... Street Map No...~ ....... Block No. ~ ......... Lot No...~... ~2hO~e,...~,Y, ...... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ .~e .. ~0.., 19.66 pursuant to which Building Permit No... ~9..Z dated ............... J~O...lQ 19. ,66 was issued, and conforms to all of the require- merits ,of the applicable provisions of the law. The ~occupancy ~or which th~ certificate is issued is .~N~8~0. Q~O..f~$l~ .dw. ell$~g .......................................... The certificate is issued ~o . .~%~.Va~.qNO..~. ....... ~%~ ........................ (owner, lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health App.,oval .. ~t~P~9~. ~9~ .~'.~..19~. ~Y. ~* Villa Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N.o BUILDING PERMIT (THIS PERMIT MUST BI~ KEPT ON,THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ot premises located ot .3~/g......~-ee~too&..~C pursuant to application dated ............................ ~T~,~z'~,e ...... :~.0....; ....... 19.~6.., and approved by the Building Inspector Fee $.,..10o/~0 ........ Building Inspector tk S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH Permit No. TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. Dlstriot Engineer District Engineer · FOEi~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..~~( ..0. 19 ............ Approved ........................................ , 19 ........ Permit No ............................. Application No....~.../..~...~ ........... (Building Inspector) APPLICATION FOR BUILDING PERMIT 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) ........... ....... .... State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Name of owner of premises .....~...Z~-)..J,..~/./~.' .~..°...~..~....~ l.Y..6..../.-~.J'J.(¥.f.-~ ....... .~......C/....&.../.,~.....O.. .............................. If applica, pt is,a corporate,~,igno~Cure,,8.f,~uty authorized officer. (Name arid title o',corporate officer) I. Location of land on which proposed work wilt be done..Map No.: ./?'/?.~:.(:~..~./~'.~.....~..~:~'..C.../~. Lot No.: ........................ Street and Number ...~..'~/~..~...~..;.t.---..~.~'..~.~...l~. ......... ~..O..~..~. ........... .(~..../~...~..~.J~...~../~..~...~.~.. ....................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................. .~...~.....~....~..1~..].~... ....................................................................................... b. Intended use and occupancy ............. ~...~.~* ......... .~.t~J.~..~.~.~.. ....... ./.~..~..~.~. ..................................................... 3. Natuie of work (check which applicable): New'Building ..... ~.. Addition .................. Alteration ................ Repoi[r .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Izst:m?ted[ Cost .... ~,, .. , ~ee ........................................................................................ (to be paid on filing this application) 5. If dw, Jelling, number of dwefling units .........~,....~..Z'.~ ........ Number of dwelling units on each floor If gaiage, number of cars .......................... - ........... -.~.,- ................................................................................................... 6. If bqsmess, commercial or mixed occupancy, specify nature and extent of each type of use .......................... 7. Dimelns,ons of ex~stmg structures, ff any: Front ............................ Rear ................................ D p h .................... Height ....z........---....:'.E .... Number of Stories ............................... ~ ,......--'-T ...................----------'-'-. ........................ Dimehsions of same structure with a, lterations or additions: Front ....... ~ ................ Rear ..... De t'! ~ .... Height ::" Number of Star es ..... .':..~'.~ . .... ~:. ...... 8. Dime"nsions of entire new construction: Front ........... ~..,,$: ................... Rear.,., .~...AT.../, ............ Depth .~....~..,....~/..., Height ...//4~. ......... Number of Stories ................ O:./.~..~--.~T. ...... 10, DoteI!of Purchase ......................... .,~'....~...~....,,~/. ............ Name of Former, Owner 11. ZoneI or use district in which premises are situated Doeslproposed construction violate any zoning law, ord na~ce or regulation? .......... /,~....~. ...................... ~ ............. Nam,~ of Architect ...................................................... Address ............................................ Phone No. ~ PLOT DIAGRAM [ ' h ~stm or ro osed and ~nd~cate all set back &mens~ons frc Locatelclearly and distinctly all buildings, w ether ex' ' g p p , ' ' - * ' property des G ve street and block number or description according to deed, and show street names and indicc whether iht!riot or corner lot. STATE OF iN EW YAPS,, ,/ ~ t c c ..... ./..(.,.~ ~~ ........ being duly Name of individual signing app~~x~~~~~ above nam ~d. He is the ~- ....... (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 and this applic~ttion; that all statements contained in this application are true to the best of his knowledge and belief; that the we rk will be performed in the manner set forth in the application filed therewith. Sworn to b~fore me this He~ Publ~, ~ate Of N~ ~. No. 30-5712~ sworn, deposes and says that he is the applica