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Home My WebLink About3195-zfrOmM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...J~.B.....~..A~te, ................................... Street Map No. ~ ............ Block No .....~ ........ Lot No. ~ .......... ~']L.~...~*~e ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... A~,....,18 ......... , 19..-66 pursuant to which Building Permit No. dated ............................ ~'t3~ ....... ,~. ........ , 19..~(~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ · .P.~r.$va. te...one...$am~ty.. ~e .1.1.~.n.g ............................................................................................. The certificate is issued to ..~.~e~..~'~'. ..................... .0W~I~. .......................................................... (owner, lessee or tenont), of the aforesaid building. l~.D.Approval ~Ttme 19, 1967 by e. ................. ............... r B'~ii~i;~' J;~pector j F01~I~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERWS OFF~CE $OUTHOLD, N. Y. BUILDING PERMIT No. 3195 z Permission is hereb~ §~anted to: · ~O0.....Cen.t~ :.A.v.e...L....~ ................ i:..2...... (THIS PERMIT MUST BE KEPT ON THE PREMISES UI~ITiL F~L[ COMPLETION OF THE WORK AUTHOR ZED) ' Do!e ....:..::...:2 ::;.::;,......:.?-.~.~.;..~.~:..,, ~..~ ...................... ( l£,.~...a~.p r.~, r.e,.d...t y...P~t ~.. ~p~.e. ~,~.)...i ..... ...................... ::..: ........... et premises located at ...... ~/.8....,~=a~..~.l~e.,..:..,.,: ........................ ~ ................................................... pursuant to application dated ............................... .-~L~.~'t3,~.~....~.8 ...... 19~6..., and approved by the Building Inspector Fee $ ~,.Q.e,.O..Q. ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH JUN I 9 1967 Date Bldg. Permit No. Y/~J'~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (g~ve deed locati'on) have been inspected by this department and found to be satisfactory. D E~tsr~ crc 5tng ~ne~. n e e r FO~M NO.I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×omined .....~¢~ ........ .(..~ ...... , 19..~...~.. Approved ..................... ~ ................ , 19...?.... Permit No....~....~...~..'~....~.. Disapproved a/c ............ ................................. APPLICATION FOR BUILDING PERMIT Dote ........................................................ , 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 adioining 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. .................................. ~./~.Z.~.L.,E,, J.~..A.. b. ........ .c..z.. ~. ~.¥....~...,1~..~..¢..?~...¢,...L.~. .............................................................. Name of owner of premises ......... ..~-../.~....~..~.~. ............. ~....f-.~../x./.~ ..................................................................................... If applicant, is a ,c,,erporate, signature, of ~u¥~thorized officer. ............ ........ .... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ~'~..~..../.~./t/'../.~...~.,) Street and Number ........ ..~...Z.~../~...~.. ........ ~.~...V...¢..~. ............ ~.~../.'~....~....~... ...... ~....(../,)...~.~.. ................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: t a. Existing use and occupancy ................................................................................................................................... P.. W. ............. ....... b. Intended use and occupancy ............................ ~/./,. ........ ! 10. 12. 13, Natujre of work (check which applicable): New Building .................. Addition .................. Alteration ............... Repa!r .................. Removal .................. Demolition .................. Other Work (Describe) ..................................... (to be paid on filing this application) If d elling, number of dwelling units ...... ~..~.. ............. Number o~ dwellin~ units on e~ch floor ..... ~.~.~ ..... If g~rage, number of cars ............... ~..~..~..~ ........................................................................................................ If bgsiness, commercial or mixed occupancy, 'specify nature and extent of each type of use ......................... Dim, ~nsions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories .............................................................................................................. DJm~ nsions of same structure with alterations or addilions: Front .................................... Rear ......................... Depi ................................ Height ............................ Number of Stories ................................ Height ...~.~ ........... Number of Stories ...... .~..L~.~ .......................................................................................... S~ze~of lot: Front ..... ~.AZ...~. .......... Rear .......... .~ ...................... Depth ....... ~..~.~ .......... Zon~ or use district in which premises are situated /~ ~ I~1 A ~ Doe~ proposed construction violate any zoning law, ordinance or regulation? Na~e of Architect ...................................................... Address ............................................ Phone No. PLOT DIAGRAM ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr, ~es. Give street and block number or desc~pfion according to deed, ~nd show street names erJor or corner Jot. / / L.ocat~ property Ii whether in~ --__ STATE OF NEW,~YO, J//K,,~ / COUNTY OF .~ ......... .... ..~...~~ ............................................ being duly sworn, deposes and says that he is the applic, ' ~[Nam~div~l~igni~g appJ~ot~n)--- -- % ~ ~ ,. , obow~ no,ed. He is the .... ~~.~.~~...~ ........................................ (Contract~, agent, ~orporate 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 applic arian; that all statements conf~Jne~ Jn this application are true fo the best of his knowledge and belief; that the )rk will be performed in the manner set forth in the application filed therewith. W ~fore me this~,_ ~~ ~ 19.....~ '~~~ ~'~ ~ ~~ Sworn to k ....... ..... of ............. , Notary Pu)lic, . ...... ~ ........... '. ~ . County (SignatEre of applier) ~ ~lc, State of N~ ~ NO. 30-5712~ ~u~li~a In Nassau C~ ~*g~ ~xplr~s March 30,