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Home My WebLink About3181-z~ORM ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. BERTIFIDATE: DF BGP. UPANGY No. ~..2~.2~ .... Date ........... 8ep. teaber... :[~ .... zg. 6.¢ THIS CERTIFIES that the building located at . .O2~h&~2d. ~ ................ Street Beixedon ~states Map No ............. Block No .... 3. ....... Lot No. 2 .& .3 ........ 80.uthnl&~ .N...Y .*... conforms substantially to the Application for Building Permit heretof, ore filed in this office dated .......... A'U~Us~;'' '8"', 19.66 pursuant to which Building Permit No. 3].21. ~. dated ............... Allg~$~;. ~ 19..6~ was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The .oecupancy f~or which this certificate is issued is . P.X'ive~%. e..ol~e -£ami'q'y · ~lvye~-~.i~'g .......................................... The certificate is issued to . .De;hie.S: .& .}~aPJ~y. ~li].~er~ ..... Owner's. .............. (owner, lessee or tenant) of the aforesaid building. ~Suffolk County Department of Health App,,oval ....... N,~, ............................. BUILDING P~:RMtT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3181 z Date ........................... Azt~?as.~.... ~ ........... , 19..66. Permission is hereby granted to: at premises located at ...... 'LO'$"~'~'"~]koC~k'"~¥"~$e~t~O~"E'~t~t~'S .......................................... ................ ~?eha.~.c%..L~.n~. ................ ~ (~ .~ho~ ................................................................................ Building Inspector Fee $....~,Og ............ Building !nspector FOR!YI NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ×am,ned ..... ........ Approvod ........................................ , 1~ ........ P~mff No ............................. Dis~pprowd ~/c ...................... ~ ................ ~ ............... ~ ~-~ ...... J/ APPLICATION FOR BUILDING PERMIT Date ..~ ........................................... , INSTRUCTIONS o. 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 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, New York, and other applicable Laws, Ordin.ances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Address of applirdant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. Nome of owner of promises .......... ~ ............................................................................ 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 ................................................. .~~..~.~,.~~'?,2C/~, 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. I:xisting uso and occupancy ........................................................... b. Intended use and occupancy .......................................................................................... 10. 11. 12. 13. I j NatUre of work (check which applicable): New Building .................. Addition Rep~ Estir If d If gl if Dim .................. Alteration tr .................. Removal .................. Demolition .................. Other Work (Describe) ~ated Cost ....... ~......~....0....~. L ...~, ,..~.. ........................ Fee (to be paid on filing this application) veiling, number of dwelling units ~ ....................... Number of dwelling units on each floor iroge, number of cars ............... · .~..,~...:~... usiness, commercial or mixed occupancy, specify nature and extent of each type of use ,,nsions of existing structures, if any: Front ............................ Rear ................................ Depth property I whether in Hel ht ........................ Number of Stories [ . D~mpns OhS of same structure with alterations or additions: Front .................................... Rear Depih . Height .................. Number of Star es ............................... t --' Dimlensions of entire new construction: Front ..... ~....~ ...................... Rear .....~....~.. .............. Depth ....... ~ ........ or, Hei~lht .................... Number of St 'es ............................................................................. Size~Jof lot: Front ............................ Rear .................................... Depth ................................ DatA of Purchase ........................................................ Name of Former Owner Zon'~ or use d strict n which premises are situated ........... ..~,..~ ........................................... DoeI proposed construction violate any zoning Iow, ordinance arian? ' Nar~e of Owner of premises .... ~..~ Address No. No, he of Architect.~:~-~.,_, ,~..~,.~.-~.~.;~..I, ........... ,AAd~essd ~ ~'~ ......................................... Phone No. No, ~' ' PLOT DIAGRAM kocat clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr nos. Give street and block number or description according to deed, and show street names and indic ~erior or corner STATE 01! N EW~YOR (, ~. t ¢ e COUNTY IOF ...~.~...~:.~...O...~../..~.....)' o.,,. Notary MARION A. ' PUBLIC, State of flew York No, 52-3233120 Suffolk Count;/ Term Expires ~arch 30, 19_~..? of applicant) ....................... ~..~.~..~ .~., ......... ~...~.?....../~...~..~ .......... being duly sworn, deposes and soys that he is the applic Name of individual signing application) above no, ned. He is the ..................... .~.O..,~f.....~....I.~...[~....C;.. (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this oppli :arian; that all statements contained in this application are true to the best of his knowledge and belief; that the v ark will be performed in the manner set forth in the application filed therewith. Sworn to I .afore me this ~. ..~... day of ~ ~ C~ ~r 19..~.~..,