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Home My WebLink About3129-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE 13F EICIELIPANCY No..Z..~.~. · · Date ................ 0~tObe~'... ~0., 19.66. THIS CERTIFIES that the building located at R-~0~' Off' ~/~ '~'~i~' ]~treet Map No ..... i~... BlockxNo ..... ~ .... Lot No. ~' "SO~hO~' 'I~'~ .......... conforms substantially ~o the Applicati~on for Building Permit heretofore file.d in this office dated ......... ~ ..... 20.., 19.~6. pursuant to which Building Permit No. ~.~.~. dated .......... ~ .... L~0 .... 196~., was issued, and conforms to all of the require- ments .of the .applicable provisions of the law. The .occupancy f~or which this certificate is issued is ~'~.'J'&~;O 'O~' i'~iq']~' ~O~.i~g ........................................... The certificate is issued t~o .~lthO~,~. ~:. ~O~Oig .(]~O'~ ....... (~. ~O~ .......... towner, lessee or ~enan~) of the afore.said building. .Suffolk County Department of Health App~roval ....... .~?. · · .~..~ .......................... Building Inspect~/ ~U~LDING (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3129 z Permission is hereby gronted to: to Make ~t~z~tu. on~ ct premises located at ..... ~q.~.~ ....... ,~.~.0,1,~,*.4)'~'~...~./~-*.-.~....?,~-~..~,g~ ......... ............... i .......... pursuant to application dated ...............; .................. ~'-~*...~0...~;., ¥9,..~, Ond approved I~Y the · Building Inspector · Fee $....~,~g ........... FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ......Permit No ......................... ::::-~--~ (Building Ins~ AP,L'CAT,ON ~O, BU,'D,NG P~RM,T Date ............. ~.~...~.....~...~...... ~ .............. . 19.6..? ....... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink end 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 Qpplication, the Bcd[ding 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 pgrpose whatever until o 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 ot,alterqtions, or for removal or, demolition, QS herein,desm'ibed. The applicant agrees to comply with all applicable laws, ordinances, bui,[djng code ond(}rect~l~tio~ .~-o/~/~'~,~,~,t~. ......... i ;~;'i ........ .... ~. ~z~.~~ Z_~ ~../....~/..~_~... ~:~ ~. ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ~ ~..~. ~. . .................................................................. Name of owner of premises .... /~.ff..'/.'-//t.~..~..'~... ......... ) ...................................... ,~.., ~.~..~,o,~b. v' ................ ,,.~ol,-v~/d--"~..i ................................... '-~ ~//~'~'4')., ............... 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 ..~ ............... z ..................................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use end occupancy ................................................................................................................................... b. Intended use and occupancy ................................................................................................. 3. Nat~ire of work (check which applicable): New Bdilding .................. Addition .................. Alteration ............... Repc ..................Removal .................. Demolition .................. Other Work (Describe) ..~'x~4..(A~.~.~......~...4..~./..~,.. 4, Estin oted Cost .............. ..z:,~..; .................................... Fee ....................................................................................... (to be paid on filing this application) 5. If d~elJing, number of dwelling units ............................ N tuber of dwelling units on each floor · If ga?age, number of cars ............................................................................... : .......................................................... 6. If b~smess, commercial or mixed occupancy, specify nature and extent of each~ type of use ............... ?.~. ..... 7. Dimensions of,~xistir),g structures, if any: Front ....... ~.'~....~. ............. Rear ...... ...~TT......~.. ............... Depth .....9~'...¢~. .......... Height .../. ......... ~.. ....... Number of Star es ...... ./.. .................................................................................................... Dim4nsions of same structure with alterations or additions: Front .............. ..~, ..~'~ .............. Rear Dept,'h ......... ;~..~.. ................ Height .....-~. ................. Numl~er of Stories ........4(_ .................... 8. Dimensions of ~ntire new construction: Front ........... ~..~. .................... Rear ............ ../.,,~.../. ..... Depth ..... ../.~ ........... Height ..../...~. ...........Number of Stories ................ ./. ................................................................................................ 9. Sizelof lot: Front. ........................... Rear .................................... Depth ................................ 12. Doei proposed construction violate any zoning law, ordinance or regulation? ... ~4...~.~ ........ . ................................. Narco of Architect ...................................................... Address ............................................ Phone No ................ Nale of Contractor .................................................... Address ............................................ Phone No. ~ PLOT DIAGRAM L.ocot~clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fr, property hes. Give street and block number or description according to deed, and show street names and whether i~ JCerior or corner lot. STATE OF, NEW YORK, lc c couNmY :OF .............................. .... "' ................................................................................................ bein~ duty es ond so~s thor he is tho ~me of individuol siflnin~ oppHcotion) obove no~ed. He is tho (Controctor, ooont, corporote officer, otc.)' of soid o~ner or owners, and is duly outhorized to perform or have performed the sdd work ond to moke end this applkation; that dl st~temonts contoined in this ~pplic~tion ore true to tho best o~ his knowledge ond thor the w~rk will be performed in tho monner set forth in the opplication filed Swam to ~efo~e me this ~ ~ /-- ......... day of ............ .............. , t9..~...~ i '~ - ~- ,,~ ~ // ......... Notary Public,/~./~...~.;.~ ....... County (Sig ~OT&R~ pUgL 6, State d New ~o. 52-3233~20 S~[~o~k Cou~t~ ~efm Explre~ M~r¢]~ ~0,