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Home My WebLink About3145-zFORM ~0. S TOWN OF SOUTHOLD BUILDING DEPA!~TMENT TOWN CLEI~K'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF' OOC:LJPANOY THIS CERTIFIES that the building located at ~/S Deephole DZ' Street ~ap ~o..x~.. ......... Block ~o .... ~ ..... ~,ot ~o...~...=......~..~%.t~e..~:'..~.9~: ....... conforms substantially to the Applieati, on for Building Permit heretof, ore filed in this office dated .......... .J..%~.~r ....~. ..... 19..6.6. pu,rsuant to which Building Permit No. ..... 31bc~....Z dated ........ ~u..~y.. ~. ......... ~9.6..6., was issued, and oonforms to all o~ tbe require- ments .of the .applicable provisions of the law. The .occupancy f. or which this certificate is issued is..P.r.i..v.a.~..~..o..n.c..f..~.i..~y., .~:4e..~.n~ .......................................... The certificate is issued t,o ...... ~?.~.~.~...$.~..hW.~l..~.k.@?. .......... .0..~..o.~. .................. (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval De(~, ~l~ 1~66 by R~ Villa Building Inspector FOB.IVJ[ NO~ TOWN OF BUILDING DEPARTMENT TOWN CLERK'S OFFIC£ SOUTHOLD, H. y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORI~ ~UTHORJZED) N? 31~5 Z., ::;:::, , :.,: ,: ,.::.:7, ,:""'~", : Permission is hereby granted to: ............ , ~.~...~.. ~... C~ ..~eZZ~ ............ :.: ............... .,......:..:.~ ........... o~m~,~, ~o~t~d ~ ....~Z~.....P~...$~..~,... ......... ~ .............. ; .............. .......... ;.: .............. ~.. ........................................ ~(~3.~¢~...~...~.,;~ ..................................... pursuant to application dated ................................ .~.i~. ....... ~'. ........ 19..6~., and approved by the Building Inspector Fee $...]:..0..'..0..0. .......... .............. ~S~ ................................ ~'-:~-'-~ ............... , Building lnspectoi' ,-~{, S-9 SCHD SUFFOLK COUNTY DEPARTMENT Date Bldg. OF HEALTH DEC ~ 5 1966 Permit No. ~J~-- TO WHOM IT MAY CONCERN: The sewage disposal facilities (Give deed location) for a structure located have been inspected by this department and found to be satisfactory. ~striot En~in~e~r District Engineer FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............. .~ ............. 19 ........ Approved .................................... , 19....q...Permit No ................................. Application No ................................. APPLICATION FOR BUILDING PERMIT ............. ..S.... ............. , INSTRUCTIONS a. This application must be completely filled in by typewriter'or in ink and submitted in daplicate 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 ocation. c. The work covered by this application m~y 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 inspe.ctidn throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. , APPLICATION IS HEREBY MADE to the Building Deportment 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, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. '"(Sighature---- --of applicant, or name, it a corporation) ..................... '~,~d~[e.ss of appli~[~t) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ....... ................................................................................................................ Name of owner of premises.....~..~... ............................................................................................. If q~c~cant is a corporate, signat~t.r~,, of duly authorized officer. (Name and title of corporate, officer) 1. Location of land on which proposed work will be done. Map No.~.~.../.~.~C..~..~..~.../~.. Lot No:...~. ........... Street and Number .~..~......~....~.~. ...... .~...~...~...~...~..'...~,......~.....~..i~/..~.~.~..~. .................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..~...O.....~....~..~. ........................................................................................................... b, Intended use and occupancy ............................................................. ~. ........................................................... 4, 5. 6. 10. 11. 12. 13. Locab property Ii whether in / Nahlre of work (check which applicable): New Building...............,....~' Addition .................... Alteration ................. Rep( ir .................... Removal .................... Demolition .................... Other Work (Describe) .................... Estir,ated Cost ../..(~.t.~...~..~....~.. .............................. Fee · , (to be paid on filing this application) If d~elling, number of dwelling units ............l ............ Number of dwelling units on each floor ..................... ' ......... If gc rage, number of cars (2.~....~.... ............... ............................................................................... i ......... If bhsiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dim~ ~nsions of existing structures, if any: Front ............................ Rear ............................ Depth ...................i ........ Heic, ht ............................ Number of Stories .......................................................................................................... Dirt msions of some structure with alterations or additions: Front ................................ Rear ............................. Dep ................................ Height .................... ~"'"1'" Number of Stories ................................ Dirt ,,sions of entire new construction; Front ..~.~g.....4. ........... Rear ..~...~.,...~..' ............ Depth .~rr.~:~..'T..~., ......... ~t ........~...,~.. ............. Number of Stories..,../.,,J,~.. ................. Heig Size :)f lot: Front ....L~,..~.~..,( ........... Rear ..~...~..'..~..~. ........... Depth .~..~7./L.,~...7, ........ .~ / Date of Purchase ..../.'.~...~...~/.. .................................... Name of .Former Owner ~-:.~..4~-~/zF/~.....~.Z~.~.~'.:~..~..l.; ........ Zorn or use district in which premises are situated....j~....L~.~t~..'~'...l,/t:;..~ ........................................................ Doe., proposed construction violate any zoning Iow, ordinance or regulation? .................................................... Nar~e of Owner of premises ./~, ./~/~....,~ .ff.../~..4~...,Address ~.tk'~k.~ .~..~...1.2~..../~,.~ ...... Phone NO.O..°..~.:T.,~.~...°. Nar)e of Architect .................................................... Address ................ Contractor"'"t/'/.~/~O.t.v:.... ~/ ///~,...l./~..~..'...AddressJ.~' /.'~..~....~.~,~;q. ..................... Phone NO. lie of ~.~D.l.~t...~..~.¥..~,. A/.'~. Phone NO./~'...~..~.~..o.~. J Nar PLOT DIAGRAM ~ clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions fro ms. Give street and block numbers or description according to deed, and show street names and indicc / STATE OFJNEw YORK ) S S COUNTY ~F .......................... ) ' ' ..~.~.]~........~..:..~...L../~ ..ff~.,. ................................................ being duly sworn, deposes and says that he is the applic( (~ame of individual signing application) above na~ed.L He is the ..~.~.~.~ ............................................................................................................. , J (Contractor, agent, corporate officer, etc.) of said owper or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his Imowledge and bell and that the work will be performed in the manner set forth in the application filed therewith. ! N J · 0 a~ ~t]t)lic, State of N Sworn to before me thru No ....... ew Yor~ ~ -- ~ · o4-yu~ll?5 Suflolk C~unt~ .......... ...... of ........ , ....... "~ LO" .F ?