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Home My WebLink About3185-zFOI~M 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT ~'OWN C~ER~S OFFICE SOUTHOLD, N. Y. I;EETIFII;ATE OF OI~OUPANI~Y NO...~...~.~...9.~... Date ..... .O.V.~.O.~...e.~....~.~. ............ , 19...6,6 THIS CERTIFIES that the building located at . .M~,ll~ .RO~d,..Sout;hc~lcl .... Street Map No.. ~ ....... Block No.. ~ ....... Lot No ..... ~ ........................... conforms substantially ~o the Applicati,on for Building Permit heretoSore filed in this office dated ......... .l~.~.gg~.t;. ~..], ..... 19~.~;. pursuant to which Building Permit No .... 31~ .Z dated ........ .~l~lg$.t; .lJk ..... 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 .............. .a.4.d~. $.o.n...to...on.,..~1.1~...~.~l.~,~g ........................ The certificate is issued t~o ....... l~ff..l~a~],~tk ....................................... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ........................................ FOI~M NO. 2 TOWN OF $OOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 3185 z Permission is hereby granted to: ............ ~ree~po~ ............................................. to ..... Ba. 1~t.. ~r~..aa!,~.i.~,~n.. ~.,~..~..~¢~g. *~weD~ :~g ..................................................... at premises located at ....~;~.~[..&..G~yo,~e..i~e~: .................................... i ........................................... .............................................. ~ou.t. hc~td.~. · · ~? ~- .~: ~. .................................................................................. pursuant to application dated ............................. -~tt~l}-....'~'~. ........ 196~..., and approved by the Building Inspector Fee $5.0-0 .............. FOI~M NO. I '~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. z_ Approved ........................................ , 1E ........ Permit No ............................. Application No....~..../...~-'..~Z ........ Disapprovedo~~~-'------ ............... ................................. APPLICATION FOR BUILDING PERMIT ~ote ....~......~1 .................................... , ~.~..~ .... 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 o 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 port for any purpose 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 o 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 oil applicable laws, ordinances, building code and regulations. ........... ........... ......... .................. (Signature of applicant, or name, if a corporation) ......... ...... State whether applicant is owner, lessee, agent, architect, engi'neer, 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) Location of land on which proposed,work will_ be done. Map No.: ......... ~ No.: ........................ Street and Number ......... ~....~ ..................... Municipality ................................. 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 ............. .~.~ ................................................................................. 6. If 7. Din Hei! Dirt DE 8. Din Hei 9. Siz~ 10. Dar 11. Zor 12. 13. Nai~re of work (check which applicable): New Building .................. Addition .... .~ ......... Alteration Rep ~ir .................. Removal .................. Demolition .................. Other Work (Describe) Fsti noted Cost ......... ~..~.. ..................................... Fee i (to be paid on filing this application) tf d~velling, number of dwelling units ......... ~.~. ................ Number of dwelling units on each floor If g~rage, number of cars ....................... .f. ,usiness, commercial or mixed occupancy, specify nature and extent of each type of use ensions of existing structures, if any: Front .......... ~.~. .......... Rear ..... ~.~ .................... Depth ~.:.~ ........... Iht ........ ~.. ............ Number of Stories .......... ensions of same structure with alterations or additions: Front ..... .~..~.~ ...................... Rear ...~.~,~. th ....~...~... .................. Height ...... ~ ............... Number of Stories ............/. ................... ensions of entire new construction: Front ......... }..~ ...................... Rear ..... ~...~. ................. Depth ...~. ht ..,~.. ............ Number of Stories of lot: Front ............................ Rear .................................... Depth ................................ of Purchase ........................................................ Name of Former Owner , or use district in which premises are situated ...... Doe, proposed construction violate//~_ , /~, ~ ',/any zoning law, ordinance or.. '~ ~regulati°n? ............ ~ ................................... Name of Owner of premises ./A~...: .~.~..Address .~...~/,,~......¢-r~JT/c~/~r~ ....... Phone No.~.....~..~ Na~ ae of Architect ...................................................... Address ............................................ Phor)er) .Nra ................ Nar~e of Contractor .~.~...~..~.~c~/,./.~..Address .~..}...~......~....'~../~,~ ............ Pho'~o.)..~.:~.Zf-).~.~ PLOT DIAGRAM ,' clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fr nes. Give street and block number or description according to deed, and show street names a~d india Locat property I whether in erior or corner lot. (Contractor, agent, corporate officer, etc.) and of said m ~er or owners, and is duly authorized to perform or hove performed the said work and to make [ile this oppli~ ~tion; that oil statements contained in this application are true to the best of his knowledge and belief; ~nd that the ~ ~rk will be performed in the manner set forth in the application filed therewith. Sworn to J ,~fore me this ......... ......... ............ Notary Pt blic, . ........ ~ ....................... County (Signature of applicant) l<lo, 52-1~580~ ~uffo~k Oouu~ f ~ STATE OF NEW ~ORI<j,. . ~ }cc .............................................. being duly sworn, deposes and says that he is the applic Name of individual signing application) ~' ~ above no~ ;d. He is the ......................... ...~...~ .....................................................................................