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Home My WebLink About3127-z~O~M ~0.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. r.I~I~TIFll]ATE OF OI]I]UPANm¥ THIS CERTIF~IES that the building located at ...¥~.~... ~.r.~.9.~..L..~ .......... Street conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ,[~....].(~.., 19.66. pursuant to which Building Permit No. dated .......... :( .;.J'.t~..e. .... .].6.., 19.~.~., was issued, and conforms to all of the require- me.nts .of the .applicable provisions of the law. The .occupancy for which this certificate is (o~vner, lessee or tenant) of the afore.said'building. .Suffolk County Department of Health App~ov al .. ~.ep]~..] 9~6 ~..by..U,, .~;Lt];~ .......... (lost papers fo~md Jan,2~1968) Building Inspector FO~ NO. ~ TOWN OF SOUTHOLD 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? 3127 z Permission is hereby granted to: at premises located at ......1~/~...-~[~..~60~.-~]r~...... .......... ....... ........................................................... .................................................. ~ ¢~a.~.~o~.tr ...~J~-~. .......................... ............. pursuant to application dated .................................. ~Tt~t~b....-.].~ ....... 19....66 and approved by the Building Inspector Fee $....1.Q,.CtO ........ Building Inspector BUILDING DEPARTMENT TOWN CLERK'S OFFICE (~ SOU'THOU), N.Y. ~ ~ ' Examined ..~...**~....~'..., 19...~**.~ Application No..~...~...~....~ ........... Approved ........................................ ~ , 19....~.1... Permit No......~...l...~.....~........~.. ........................... . .......... ii'i'i?.'. ........ ......................... ~ ............................. ,1~ (''/ APPLICATION FOR BUILDING PERMIT , ate .............. ................................ , ,9...(...,. ..... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitte~l 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 port 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 ir~pection 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 H.EREBY 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, ordinanc~s~building code and regulations. State whether applicant is owner, lessse, agent, architect, engin~r, general contractor, el~trician, plumber or builder. ~a~p; ,:j~:~: r a°[oP~omrL;:i :::~~J ' ............................................................................ (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ........................ StYeet and Number ~ ~ Municipality State existi,ng use and occupancy of premises and intended use and occupancy of proposed construction: .......... - ....................................................... mtenoed use and occupancy ..... ..~....~....~: ....................................................................................... 3. Nature of work (check which applicable): New B,~i din~ ~..~ ............... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ......... L.::.... Other Work (Describe) ........................................ 4. Estimated Cost .................~. ................................. ...tee ...~ ...................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ......................................................................................................................... ~ ..... 6. If business, commercial or mixed occupancy,,specify nature and extent of each type of use ........................... . 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height Number of Stories ' Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construct on Front ..~..~' Rear .~...~. Height ~- ~' ~ Number of Star es ~ ............................. 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regu arian? ................ 13. Nameof Owner of premises/7~....~~Address ~-~ ~' ....... ~..~..~...~....'~..: ......... ~none r~o ..................... Name of Architect ..... .,~ .................................... ; ........ Address .......................... Phone No ..................... Name of Contractor~..~.~...Address .~iiiiiii Phone No.../...~.~...~..... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OJ: NEW YORK, '~ S S COU N 'I'~1 OF ............ ...... ........... ~ ......... {.~~....~ ................ L ........ being duly sworn, deposes and says that he s the opp cant (NFame of individual, idual si~G4~'pp,~tion)si ppli rich) , ,. aoove named. He is the ............................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make 'and file this application; that all statements contained in this appIJi:ation are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. · S..w..~ .r.~..~- ~.f..°.~7 dmaey t ~ ~s ......... ,~ .................. , 19../a~ ,o,o. -- '' N A ~EGENT '~' U ........ · NOTARY pUBLIC, Strife o New Yorl( No. 52.3233120 Suffolk County Term Expires March 30, 19.~:~