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Home My WebLink About3164-zFOI~M N~O. 4 TOWN OF SOUTNOLD BUILDING DEPAETMENT TOWH CLEHK'S OFFICE $OUTHOLD, N. Y. EIEI~TIF'lOAT!E QI= OGOUPANI~¥ No..Z..2.6.40 .... Date ......... J. aritlar.y..3L ......... 196.7., THIS CETtTIFIES that the building located at ....... O~tf. ttng ............. Street Map No .... ~ ..... Block No .... ]Ot[X ..... Lot No ...... ~;]t]{X ............ (~EI.t:~hOgtle. confm'ms substantially to the Applicati.on for Building Permit heretof, o~e filed in this office dated ....... :... J/%y..19 ...... , 19.66 pm'suant to which Building Permit No... '~164 jig. dated ........... July..21, ..... 19.66., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy f. or which this certificate is issued is ......... a~cll~.;~OB..tO..bUS. IBe~$..building ................................ The certificate is issued ~o .... ~Olt~ .Ann .Terl~ ................................ , ..... (owner~ lessee or tenant) of the aforesaid building. ,Suffolk County Department of Health Approval ......................................... Building Inspector FORM NO. 2 TOWN ~F $OUTH~LD BUILDING DEPARTMENT TOWN CLERK'S OFFJC~ SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NV 316 Z Dote ................................... .~t~,~ ....... ;~],..., lC)...fo6 Permission is. hereby granted to: · ~-°~etm..~..~.C.-~..~,~..A.,...~.~ ........ ........... ~,~;h~,~,......~-~.,.~.,, ................................. to ...B~-~ ot premises located at ...G~f.~...&~..&~..~e~.~t...i~a8 ................................................................... ........................... L~:~J~.~Lt~,* ,f ' - · .. ~ ¥ '~: ~ .......................................................... pursuant to application dated ........ ~, 19.~.., and approved by the .................................... ~....~4, ..... Building Inspector Fee $"~egO ............. Building Inspector FORM NO, 1 TOWN OFSOUTHOLD BUILDING DEPARTMENT T~WN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............. , 19........ ~/~ Approved .~. ...................................... , 19 ........ Permit No. ................... '~ / ~ (~.........~ Application No. Disapproved a/c .................... ~.~,~ ............. ~ .......... APPLICATION FOR BUILDING PERMIT 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 a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the wort. 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, os herein described. The applicant agrees to comply with all applicable laws, ordina, D~es, building code and regulations. k/ (signatUre of applicant, or name, if o corporation) ...... ~ ohar. t .. ~oacl.~ ...~.¢~t~t,ho '1 d.s... N. ,Y.o .......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electricibn, plumber or builder. Name of owner of premises ..... L~,~...AD,..q....~e.r.~ ................................................................................................................ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done..Map No.: ........ .~. x.7~ .................... Lot No.: .;:c.x..,~ ............. · · Cutch,o. gue ~ N. Y. Street and Number E/.S~..G~.m£.£:t~g...S.t..&..Ma.~.~..R~ad,~ ............................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~.tl, S.:~ D,~. ~ ,~.. · ~.'~ ;L~ f~iTt ~ ........... ..~.~...~',.~) .................................................... b. Intended use and occupancy ............ ~.~...~..e.....kr%.~.~...f~:CJ,...~.~..~.~.o.~..~c...~l.~.~.~f~..~.~.P~ ................................... 4. 5. 6. NatUre of work (check which applicable): New Building .................. Addition ...... ~ .... Alteration ..... Repair .................. Removal ....~:~,. .......... Demolition .................. Other Work (Describe) ................................... !' ......................... (to be paid on filing this application) If d~velling, number of dwelling units ........ t'~t'te. .......... Number of dwelling units on each f~loor ........................ / If ~rage, number of cars ......................................................................................................................................... If ~usiness, commercial or mixed occupancy, specify nature and extent of each type of use Dimensions/of existing structures, if any: Front ............................ Rear ................................ Depth .................... Hei~tht ........................ Number of Stories ............................................................................................................. Dim'ensions of same structure with alterations or additions: Front .................................... Rear Dep~th ................................ Height ............................ Number of Stories ................................ Dirdensions~ of entire new construction: Front ............... .'l.'l....f~. ........ Rear ...... .~...~. ......... Depth ..... ..~.~....~...t... Height .................... Number of Stories ........... .O.l'~ ............................................................................................... Dot of Purchase ........................................................ Name of Former Owner ...... ~.,,..~e~.-~ ............................. Tar e or use district in which premises are situated ...........tL]~9...a.~i,~.'t, ................................................................... Doe proposed construction violate any zoning Iow, ordinance or regulation? ............... 1%O .................................... Nar ~e of Owner of premises ..~o&s..Ik.~...~o.Z~t~ .........Address ..f~.(~ll.'~,,h.p..],~. ....................... Phone No ................ Nar ~e of Architect ...................................................... Address ............................................ Phone No ................ 10. 11. 12. 13. PLOT DIAGRAM I.ocat9 clearly and d~st~nctly ell buddings, whether existing or proposed, and indicate all set-back dimensions fr, property li,nes. Give street and block number or description according to deed, and show street names and indic~ whether interior or corner lot. STATE CFi NEW YORK, ' } c c COUNTY pF .~ .............. ~'~' ................. j ........ ~..~...~;.~.~.J~.~ ............................ being duly sworn, deposes and says that he is the applic, Name of individual signing application) ,above na~ed. He ,s the .............................. ~.~..~..~. ........... ~ .................................................................................... (Contractor, agent, corporate officer, etc.) of said owlet 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 we rk will be performed in the manner set forth in the application filed therewith. Sworn to b, ~fore me this .............. of ............. d.s..b ........... ' ..x ..... ~ NOTARY PUBLIC, S[~e of ~o~ Yo Ho. 52-3233120 Suflolk Country )erm Expires ~arch 30,