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Home My WebLink About3125-zFORM 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOW~ CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFISATE OF oCGUPANG¥ No.Z .2.~.~ ..... Date .............. 0~tObe.1~.. 2.1 .... 1966. THIS CERTIFIES that the building loc,at~d at .~/~ .(~11//~t~a .D~. .......... Street m~a~ion 1,'~no~ ~ · ap ~o ............. Block No ............. Lot No..~0.~ ..... E~..}'~aZ~O~, .N.,~... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ ....... ~., 19~. p~rsuant to whi~ Building Permit No. ~2~' .Z. dated ......... ~ .... ~ ..... 19.66., was issued, and conforms to all of the require- ments ,of the applicable provisions of the law. The .occupancy ~or which this certificate is issued is ...~r~a~o. o~e. ~.ty. ~we.tli~g ......................................... The certificate is issued to . .~obe~. I%. · ~,~1~,~ ........ O~le~. ................... (owner, lessee or tenant) of the a~oresaid building. .Suffolk County Department of Health Approval .... ~B~ .... '20~' '1~'~' ]~ 'Villa Building Inspector TOWN O~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3125 z Permission is hereby granted to: Robert 8chroeder Orient~ ~L '~. Build new on~ family dwelling lot ct premises located at ................... ~? ...~.z~.~.~.~.~..~., ........ ~.~..~...~ ............... pursuant to application dated ............. ~...~. ........ t.~. , 19~..., and approved b~ the Building Inspector 10,00 Fee $ ........................ Building Inspector ~0~ NO. 1 ?OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. Jj' Disapproved a/c .............................................................................................. (Building InspeCtor) APPLICATION FOR BUILDING PERMIT Date ....... ...................... , ..... 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 o 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 oil applicable laws, ordinonc~e, sr~uJJdi~g cqlde aj3d, regulatiop;~. .... ............ (Signature of applicant, or name, if a corporation) (Address of applicant) 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.'~..~.. ................ '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 ................................................................................................................................... b. Intended use and occupancy ................. .~....m~..~ ...................................................................................................... 3. NatUre of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repc~ir .................. Rem~qvol .................. Demolition .................. Other Work (Describe) ..................................... 4. Estimated' Cost .............. ~/'z.~../..~ ......................... Fee ...................................................................................... j (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... /. ................ Number of dwelling units on each floor ..... x;:.r:: ........... If gllrage, number of cars ...~ ................................................................... '. ........................................................... 6. If kusiness, commercial or mixed occupancy, specify nature and extent of each type of use ,~r;~...~¢..:~ ..... 7. Dim ~nsions of existing structures, if any: Front .......: .................... Rear ........ z;: ..................... Depth ...;.:::~i ......... l-lei,~ ht .......... -Z:'. .......... Number of Stories .......... :. ................................................................................................. Dim ;nsions of same structure with alterations or additions: Front " Rear ....';:k.::'z: ........... Dep h Height .............. ~:.-:: .......... Number of Stories 8. Dimensions,gl.entire new construction: Front .~ ...... ~.(~.~ .......... Rear ..... ~.~..~f~'.... Depth of 1 1. Ton or use district in which premises are situated 12. Doesi proposed construction vio~,~e c~ny z~oningt,..)_l. ' ~llaw' ordinance or~ ,Lg/~/I}~ ~regulati°n? 13. Nar~e of Architect ...................................................... Address ................ Na e of Contractor .................................................... Address .......... '.: ................... ;.: .......... Phone No. PLOT DIAGRAM Locat~ clearly and distinctly otl buildings, whether existing or proposed, and indicate all set-back dimensiens fr property nes. Give street and block number or description according to deed, and show street names and whether in1 erior or corner lot. STATF. OF jNEW YORK, } c c COUNTY ~)F ............................... ,f "'"' , ...... ............................. be,rig duly sworn, deposes and says that he is the c~pplica Name of individual signing application) above nam,d. He is the ....... ~ ......................................................................................................... : ......... (Contractor, agent, corporate officer, etc.) of sakJ ow~er or owners, and is duly authorized to perform or have performed the said work and to make and this applic~tion; that all statements contained in this application are true to the best of his knowledge and belief; that the wcrk will be performed in the manner set forth in the application filed therewith. Sworn to b~ fore me this ........... dey ot ............... , :D D Jk i '---Fi' ,, ~,,v/ //~? ! , . ....... ~.~,.~ ...... ]...t..:....~ Notary Pub[lic~~County ,,~_~,~,/ (Signature of applicant) I NOTARY PUBLIC, ~¢~to of ~ew VO~{ / ~/ I No. 52.0618100 Suffolk County I Corem,ss,on Exp,res March 30, 19..~_7