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Home My WebLink About3158-zI~ORM 1~0. ~ TOWN OF SOUTNOLD BUILDING ~EPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N, Y. CERTIFII:IATE OF OCCUPANCY No. Z..I~619 .... Date .............. llavembe~... 30.., 19.6~ THIS CERTIFIES that the building located at ~/S'-'A'~bg~' '~l' ............... Street Map No. 'Tuthit'l' · Block No .... :g~ ...... Lot No.~...]~tll~,t. ~ ............. conforms substantially to the Application for Building Permit heretof, o~e filed in this office dated .......... ~TI~I~...~]~. .... , 19~. pu.rsuant to which Building Permit No..~.~. g dated ........... ~r .... .~:~.., 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 ....P~ivale 'oIm' i~a~ai'ly· ~tve'~li~tg ........................................ The certificate is issued t,o . .~O~ltr~.. It[.t~!319~i~b~ .......... (owner, e~ssJe~l~or .................... tenant) of the aforesaid building. Suffolk County Department of Health Appi~oval .......... 1~1,~ ......................... Building InspeCtor FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL LL COMPLETION OF THE WORK AUTHORIZEISi N? 3~58 Z Date ..... ........ :: ~..., .:..'....: ...~.~,~.~'..'.~ .~.~ .;;. Permission is hereby granted to: - · .~ep~g'.-',. ....... ~..:.;:-;...--,..,.: .... ....... ~Tg...O~'~ ......... '"'.." '"": ......... : ...... ............ ~ .................. : ...... ;..~:....~; ...... to ..... b~'~"au"'~'~C~o~"ou'"~n'"e~'"~t,~1l~ ............... ........ : ....... :"';'"'~ ............ ............................... : ................ : .............. J. ............. : .............. ~t premises located at ..~..~..,~F~ ................. ; ........ ; .................................... L ................ :~...; .... ......................................... Lo,u~,~.r ..~}[.~ ......................................................... pursuant to application doted ................................... ~'i~' '~"'-'~'~ ...... !9..~., and approved by the Building Inspector NO'I: Approvee by ~-Appeals J~ty ~ 1966 Fee $..~..0.0 ............ Building InspectorI FO$O. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ,...}/~...~...~.....~...'...'~...., 19 ~ (o Approved .....~..~.....~:....~...../.....~...'~......, l~i.~.'ili. Permit No..~..../...:~....~...~ Disapproved a/c .....-'-w'---~.....;...:...g.......'~m.....~...~.c.'..~z.;:~.~.~- .................................... ....... ...... .......... (Building Inspector) Application No ............................. APPLICATION FOR BUILDING PERMIT Date ............... J. lz.r~... ~.;~ .......................... , 19..~...6. ...... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b, Plot pl(~n showing location of lot and of buildings on premises, relationship to adjoining premises or punic 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. APPL[CAT[ON 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.onces 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) No~th Oak D~ive, Lau~el~ N.Y~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general ~tractor, electrician, plumber or builder. Name of owner of premises ........ .'[.Q~..~,..KT~0.~P~T~Q .............................................................................................. If applicant is o 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.: ................................ t....~.. Lot No.: ........................ Street and Number ........ .~.~)~..~.~.~....~.~.....A.'.~.~..~.....~..~?..i..~.e..~...~.~.~.e.~.~.~.~..~....~.Z..~. ...... : ...... ~ .............. i .................... Municipality 2. State existing use and occupancy of premises and intended use and 6ccdpancy of proposed construction: a. Existing use and occupancy .......... ..D~..~..],.~:~Jg~;....h...O..U..~...~. ....................................................................................... b. Intended use and occupancy ........ ~tZ~.t, ZT.t0.~.~O~..Q~...CJ:l,~i~g..~.OX~,..l~ACJ..~C~..9,j~. ............................. 4. 5. 6. 10, 11. 12. 13. kocat property I whether ir NatUre of k (check which applicable): New Buill .................. Addition ...,~ ........... Alteration Repg~r .................. Removal .................. Demolition ................ ... Other Work (Describe) Esti~nated Cost ......~.05.Q~.Q0 ............ ..................... Fee [ (to be paid on filing this application) If d~,eJling, number of dwelling units ............................ Number oF dwelling units on each floor / If g~rage, number of c~rs If L~usiness, commercial or mixed occupancy, specify nature and extent of each type of use Dirdensions of existing structures, if any: Front ......'~'.~L~...Z..?. ...... Rear ...... ..~...~..~...~.. ........... Depth .....~'...~. .......... Height ........................ Number of Stories O 6x ~'~ Din~ensions of same structure with alterations or additions: Front .................................... Rear Dep~th ................................ Height ............................ Number of Stories ................................ Di~ensions'l of entire new construction: Front ....... ..~....~.. ..................... Rear ...... ~..~i..-'. ........... Depth .~.~....~.. ........... Hei, iht .................... Number of Stories Size of lot: Front .......................... r. t<ear ..................... Zon or use district in which premises are situated ..... A.~z,.:L~t.~.~...e,~l..~e~l~.~l~. ....................... Doe proposed construction violate any zoning taw, ordinance or regulation? Nar ~e of Owner of premises ~l'.0.}~l'...}[~..~.0.[~.~l'~..'~ress ............................................ Phone No. Na~ne of Architect ...................................................... Address ............................................ Phone No. PLOT DIAGRAM ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions ~es. Give street and block number or description according to deed, and show street names and erior or corner lot. STATE OF NEWlgYORI(Tjpp( .................... ~'i~,...~.0.~:~.~.~. ...............( ............... being duly sworn, deposes and says that he is the Name of individual signing application) above narhed. He is the .................... g~l~ ........ j (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 applic~ation; that alt statements contained in this application are true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. ~Sworn to Before me this Notary Public, of applicant) ~ Term Dpires ~.q~'ch 30, ~.967 1 ' y 3 0 s 0 r r" l � v 7 I � II - � YI �LaJr�G Pyr. �/