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Home My WebLink About3165-zFOI~FI ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'FOWN CLERK'S OFFICE SOUTHOLD, N. Y. OEI~TIF|OATE OF' OOOUPANOY No. Z. 2~6~]. .... Date ........... 02tO.heP.... 2~ ..... 19.66. THIS CERTIFIES that the building located at W'~S,, .A'1¥~]~3- .~]ae ......... Street Map No, ..~ ...... Block No..~,~ ........ Lot No.. ~ ..... CU~;~h~gue¢ .]~.,.Y, ..... conforms substantially to the ~kpplicati~on for Building Permit heretof.ore filed in this office dated ........... ~U'..~y' .... ~.~.., 19.(~6. pursuant to which Building Permit No..~.~.,~. dated ............. ~T~y'..~., 19. ~6' 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 . 'P~l~,~'a~e · ~:t~' ':~a~[:k~ 'd~-~2' ......................................... The certificate is issued t,o . ]~]~. & .]qX,.g '~'4'~:.q.~'[q~ '~'g~;0~' ', ....... 0w~aex'~ ........... [owner, lessee or ~enan~) of the aforesaid building. Suffolk County Department of Health Approval .0C.q~.. 2k~..~6. ~r. R, · .~.i~.~a ....... FOI~i~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLER~:'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN~FIL FUEL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: ...... ~,,.~u~t...~oz~e.~..~-~....i/C.:,~.~Z~i.~, ~e'~l~rr~..... ~ ~ -~:~,. .......... to .. 3~t,~ .~.. ~.~c~..e~e...f'e~.i.Z.y.. 4t~ '~'~i.t~§ .................... : ................ ..~ ....................................... ..... at premises located at ..... ~/.~.....,~.~¥~.}1.~.~...]~,~ ..................................... , ...... ...... pursuant to application dated ............................. ~[.~.~.~r. ......... ~]: ........ 19~6..., and approved by the Building Inspector Fee $'~O-,'OG ........... FOl~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..~. ........... , 19 ........ Approved .... :.~. ................................ , 19 ........ Permit No ............................. - Disapprove~l a/~ ............... ....~:~ .............. ;.~ ........ ~~ ..... ' Application No ............................. APPLICATION FOR BUILDING PERMIT Date ............. ~..q~... ~, ............................... 19...~.6 ..... 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 thb 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 port for any purpose whatever until o Certificate of Occupancy shall hove 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 comp y w th all appl cable laws, ordinances, building code and regulations, (Signature of applicant, or nome, ~: o corporation) J ...................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... .q~c~z-. .................................................................................................................................. i ....... Name of owner of premises ....... ..~.?..,.....&L..~.~.~.,...!~.$].,].;L~.~.,..J.~,~..e, 3D~ ......................................................................... 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 ..... .~.:~.~...;~.~.~...~.~.~.~t~;~.....£.~2~:...z~/c)...z~..~£..z~&~..~&.~.~,~ ............. 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 ....~....;.~..~.~-.~2'....~..¥.~.~k]-,1,~ ................................................................................... 3. Natqre of work (check which applicable): New Building ...... ~; ......... Addition .................. Alteration ............... Repdir .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Esti~ated Cost .......~3J,¢~.c~0.~ ......................... i .......... Fee ....................................................................................... I (to be paid on filing this application) 5. If d~,elling, number of dwelling units ............3, .............. Number of dwelling units on each floor ......................... If glrage, number of cars ..... ~. ................................................................................................................................. 6. If b?siness, commercial or mixed occupancy, specify nature and extent of each type of use ...... : .................. 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Heiglht ........................ Number of Stories .............................................................................................................. Dim~,nsions of same structure with alterations or additions'. Front .................................... Rear ......................... Depih ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ~.~...~ ...................... Rear ..... ~¢J..t.8~ ........... Depth ....~.0 ............ I-lei~ht .................... Number of Stories .......... ~ .................................................................................................... 9. Size[of lot: Front ....... ~D.O .............. Rear ........ ~I..QO,..,I'J.'~. ............. Depth 10. Dot4 of Purchase ........................................................ Name of Former Owner ..................................................... 11. Zone or use district in which premises are situated ................................................................................................. 12. Doei proposed construction violate any zoning law, ordinance or regulation? ....... ~ ......................................... 13. Nar~e of Owner of premises ........................................ Address ............................................ Phone No ................ Nan~e of Architect ..~.~. ..... ~'"."'"~'~7 .......... Address ......]~'i~ ........ ~ No ................. Na~e of Contractor ..~.~.~.~t..-,~.~c¥~.m.....~..¥.~.~..Address .......................................... No.'.~.~.'.~..r..~.., PLOT DIAGRAM Locate clearly and &st~nctly all braidings, whether ex~stmg or proposed, and ~ndmate all set-back d~mens~gns frd~rr property libes. Give street and block number or description according to deed, and show street names and.indicd~t~ whether int,'erior or corner lot. Zoo., L~ 2 ' STATE OF!NEW YORK, ,COUNT?' ~F ................................ ~' ~'°' .................. I ............................................................................... being duly s~varn, deposes and says that he is the applic, !Nome of individual signing application) above no ed. He is the ..................................................................................................................................................... ~ (Contractor, agent, corporate officer, etc.) of said owher or ownerS, and is duly authorized to perform or have performed the said work and to make and this opplicbtion; that all statements contained in this application are true to the best of his knowledge and belief; that the wc~rk will be performed in the manner set forth in the application filed therewith. Sworn to bbfore me this ' ' - .~C .............. .~.~...¥...x: ...................... ........ Notary Pul~lic,, ~.~......~...:.. Term Expires IViarch