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Home My WebLink About3155-zTOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OWI~ CLERK'S OFFICE SOUTHOLD, N. ¥. I:I£RTIFII~ATI: BI:' ~UPAN~Y No. Z..2667 .... Date ............... :L~e]~ea':rY' &3.', 196.~.. THIS CERTIFIES that the building located atlai~le .]4eOl~..]Rct. & .t]ezlz~e~;. J~aStreet Map No..X35 ...... .. Block No. ~%~ ........ Lot No.~....SO~&~I,l(~3:et)..1~.~., ............ conforms substantially to the Applicati, on for Building Permit heretof.~re filed in this office dated ......... ~Xl~y...~[2 ...... , 19(~. pm'suant to which Building Permit No. 33.~~. ~. dated .......... ffxl.'L3r...ll~ ...... 19.6~,, ~vas issued, and conforms to all of the require- ments ,of the applicable pro¥is~ons of the taw. The occupancy 5or which this certificate is issued is .. P~oilra$o..o1~0. l'a. nti.~.y · dwe?,.-q'ing ......................................... The certificate is issued ~o ...~[2.S,. ~a~.y.~z~al~ ..... Oz~i-R~.~. ...... .. .................. (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval . ,0.~l;...~9.~ .~L.9.66...bY. .JR.,..Villl~. ..... Building Inspector FOI~M NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3155 z Permission is hereby granted to: ~o1~ smi~.~ ..~ui.~.d.i,~..& ..~n.~¢~ ~... A/¢ ,,~4~y., ~ ................... 8¢,~.~eld. ......................................... to . ~i~..~..~e...~a~&~ ;~-.~1~ ................................................................................... at premises located at ...~/S..~&~e..}~e~..~..&..[f/~..~$~..~a ........................................... ......................... ~.~i~:..P~T...~v~t~d.~..~, ~, ................................................................ pursuant to application dated ................................ ~tX~J.....~ ......... 19.~.., and approved by the Building Inspector Fee $..~Q.,.Q.Q. .......... Building Inspector s-9 sUFFOLK COUNTY DEPARTMENT OF HF~J~TH Bldg. Permit No,, /0~"~,.,~, Z_ TO WHOM IT MAY CONCERN.. The sewage disoosal facilities a~0r a structure located at / (Give deed locomotion) -- have been inspected by this Department and fo~ to be satisfactory. District Engineer"' FORH NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. Approved £~ '~ r~... ~....~...'5~ ~ ........................................ , 19 ........ Permit No ............... Disapproved a/c ............ ~~~ ......... .......... .[~../.i (~ In'~'0 ................. ................................ APPLICATION FOR BUILDING P££MIT -.'Kb L I ............ Date .................. ......... t ........... '~' ............... , 19 C,C~ 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 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, Ordinances or Regulations .for the construction of buildings, additions or alteratibns, or for removal or demolition as herein desc(ibed. The applicant agrees to comply with al app icab e aws, ordinances, bui ding code and regulations. (Signature of applicant, or name, if a corporation) ............................ ~..(?~:?.L[~.~.gt.~,.(=.~ .......................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ....~j~..~.. 3.. L,, .~.~,M ~;z-, 1.~, ·,~- ............................................................................................................................................................ Nome of owner of premises .~..~...% ............ g.~.a~... ¢..L:.-*.4.k If applicant is a corporate, signature of duly authorized officer. ......... ............. :..: ........... ~ (Name and title of corporate officer) 1. Locat'ion of land on which proposed work will be done, Map No.: ........................................ Lot No.: ........................ Street and Number ~c,~/~z--/¢,~r_~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of propos~ construction: a, Existing use and occupancy .................. q ................................................................................................................ b. Intended use and occupancy ........... ~ff.~.4,~.~ZY.~.~.~ ................................................................................... Natgre of work (check which applicable): New Building 3. ' ~'~ Addition .................. Alterotiorf ..... [.: ....... Repc ir .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... 4. Estin ,ated Cost ............... ~.~...../.~.~.~..'..:.~.~ .................... Fee ........ 4P.:.:.?~. .................................................................. (to be paid on filing this application) 5. If d~telling, number of dwelling units .......... ,/ ................. Number of dwelling units on each floor ......................... If gc rage, number of c(lrs 6. If b,lusiness, commercial or mixed occupancy, specify nature and extent of each type of use ............... ......... 7. Dim, msions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Hei! qt Number of Stories Di~¥insions of same structure with alterations or additions: Front .................................... Rear ........................ Dep[H ................................ Height ............................ Number of Stories ................................ 8~ Dirr~nsions of entire new construction: Front ......... .,~,.~.. .................... Rear ....... >2..-~. .............. Depth ..,~.~ ........... He !Iht ....~.z~.. .......... Number of Stories ....... ~./. ....................................................................................................... 9. Size of lot: Front ....... /~.~..~.. ........... Rear ............ /./.~,J.~.. .............. Depth ...... /..~,...m. ............... 10. Dat~ of Purchase .~././....,.~ ........ /..~.~/.~ .......... Name of Former Owner ..../2'..~../~.......~.',~.~-~ ........ · t ich re e are tuate 11 Zon~orusedistr'c 'nwhchp m's s s' d ................................................................................................ 12. Doe proposed construction violate any zonino law, ordinance or regulation? ........................................................ 13. No e of Owner of premises ./~?x~.....t'~.:..~?~ ...... Address ............................................ Phone No ................. Nor ~e of Architect ...................................................... Address ............................................ Phone No ................. Nar ~e of Contractor ...... PLOT DIAGRAM L.ocat~, clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions fr( property li~es. Give street and block number or description according to deed, and show street names and indic( whether in: erior or corner lot. / STATE OFmEW YORK, COUNTypF ................................ ........ ~4'f.E4 ......... ~ac.~.z.~. .......................... being duly sworn, deposes and says that he is the applic~ I(Name of individual signing application) above ,'o4ed. is ....... ........................................................................................................ (Contractor, agent, corporate officer, etc.) of s~id o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this applidotion; that all statements contained in this application are true to the best of his knowledge and b~lief; that the wbrk will be performed in the manner set forth in the application filed therewith. Sworn to b ~re me this ........ ......... ........ ~ {~ ~ /~ / ~ .............. ~.~ .......................... :7/ ................... Notary Pu ~lic, ~.~..J~.....~..~...~~unty ~ (Signature of appllcant) [ MARION fl. REG~./., // o. 52-3233120 SuJJ~ F / -