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Home My WebLink About3169-zFOR~V~ NO. 4 TOWN OF SOUTNOLD BUILDING DEPARTMENT '1'OWN CLERK'S OFFICE SOUTHOLD, N. Y. r. ERTIFICATE OF' OEICUPANO¥ No. Z 2644 Date ......... ..i~...~.~..a.~.y,, .3.1. ......... 1967 THIS CERTIFIES that the building located at .,, ,V.a~/i~.O.B.R.O.~%~ ........... Street Map No. 1,56 Block No. JiXX Lot No. 304 Clt~ch~_que conforms substantially to the Application for Building Permit hereto~o,re filed in this office dated .......... .~.¥!~..~.5. ...... 19.6.6.. pursu'ant to which Building Permit No. ~.~6~..~. dated .......... .~'.t!l.Y..~5 ...... , 196.6.., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .occupancy for which this certificate is issued is ...I~..Z'.t..V..~.t?...97..~.a.9.~. .......................................................... The certificate is issued to ....~I.~.1..V.t..11..H..~?..~. ,~.~.n. ..................................... (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health AppRoval ......................................... Building Inspecto~7 FOl~l NO. 2 TOWN OF SOUTHOLD BUILDING DEPAF:TMENT TOWN CLERk'S OFFICE $OUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3169 z Permission is hereby granted to: .......... · V. atas.C,~r,..R~>a~ ............................ : ........... pursuant to appl!catlon dated:.., ...................... i..~ ........ ~..~ .......... 19~,~.., and approved by the Building Inspectbr Fee $.~1.~,0 ...... ~ A ,z~uild~ng I~sp~ctor NO. 1 I~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (Building Inspector) Application No. APPLICATION FOR BUILDING PERMIT Date ............... ~.....~.~....?.. ........ , , 9.....~...~.... INSTRUCTIONS a. This application must be completely filled in by typewriter or ir~ 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 work. 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,,~N.ecw York, and other applicable Laws, Ordinances or Regulations for the construction of buildings, additions or altergfions, 'gr for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ording'nces, b~bilding code ?/J regulations. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... .~ ..................................................................................................................................... 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 ............................................................................................................... .) ................. .~.....~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ...~M~.....~....'9~..?,...~-.....~..~...°....'~....~-.. ........................................................... ' ........... b. Intended use and occupancy ......~.~..~......~....~....~...~...G.....E... ....................................................................................... 4. 5. 6. 8. Dirt Hei 9. Siz~ 10. Dat 1 I. Zor 12. 13. Nar Nm Nar property lines. Nat,~re of work (check which applicable): New Building ...... ~ ......... Addition .................. Alteration .............. Repair .................. R~l,moval .................. Demolition .................. Other Work (Describe) .................................... Estir}nated Cost ....L.,......~....~...q..:.9..@. .......................... Fee ......-~..: ............................................................................. I (to be paid an filing this application) ............................ Number of dwelling units on each floor ....-:: .................. If d,we[ling, number of dwelling units If g?rage, number of cars ............................................. If l:}usmess, commeroal or m~xed occupancy, specify nature and extent of each type of use ........................ Dimensions/of existing structures, if any: Front ....... .~...~..~.~.'.[ ........ Rear .......... .~...~.~...o..'.'. ....... Depth ......~...~..~..°.:/. ....... /.~.. ........... Number of Stories .............~ ............................................................................................... Height ~ ,r Dim~ensions of same structure with a.lterations or additions: Front .................................... Rear Dep}h ................................ Height ............................ Number of Stor~es ................................ ;nsions of entire new construction: Front .......... .~...~..:t..°..:.f. ............ Rear ........ .&..~.~ ........ Depth ........... .~ ...... ~ht ......... :7 ......... Number of Stories .........../. ................................................................................................... of lot: Front ............................ Rear ......... ./ .......................... Depth ............................... of Purchase ........................................................ Name of Former Owner ............................................... e or use district in which premises are situated ........ ~.~'...~..f.'.~.~..~..~..~..& .............................................. DoeSt proposed construction violate any Toping law, ordinance or regulation? ........... ..,~....o. ...................................... ~e of Owner of premises ./~..~..~..v'.(.¥..,.L~...~.¢..~...'~....~...¥....'k/..Address/...~.o.....~.~..¥..~.(~._.M.,....~..~., .......... Phone No.'7~..~.:'...-~..~ ~e of Architect ............. .~...~...'k'(. ~ ........ ~. .................. Address ............... ,,~..~......~, ............ Phone No ................ ~e of Contractor ............ .~.~.~....'~..~ ......... ~ .................. Address ~'u re~/o~ ~;~J~h~ ............................................ ne No ................. PLOT DIAGRAM I,ocat clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr Give street and block number or description according to deed, and show street names and india whether in erJor or corner lot. _ ~4'.o't , ~? STAT-E--~f NEW YORK, I S S ~/r? ~J 5 7~o ,J /~ ~ ~ CO/I~N TY,,. ~ )F ........ R",~ ................. ~. ~ ....~..~.~.. ................ ~ ......................... being duly deposes and soys that he is the applic ~bo-~ve~n~ a.._~.n.n.m~f-'~idua, signing application) sworn, ~d. He is the .....~..~....w'...~..-..~. ............................................................................................................................. (Contractor, agent, corporate officer, etc.) of said oYner 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 knowledge and belief; that tF .rk will be performed in the manner set forth in the ed therewith. Sworn to I: me this ....... Notary Pu )lic, (Sig of applicant) State of Suffolk County ]~on [x~rea March ~O,