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Home My WebLink About4029-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. P. ERTIFICATE DF OCCUPANCY No.. Z. 3361 ·. Date ..... ~r...l?.w .......... 1968. THIS CERTIFIES that the building located at Btam4. &venu~ ............... Street Map No ............. Block No ............. Lot No. .~tt;~,t;tlCkw · N~..YO~k ......... conforms substantially to the Applicati. on for Building Permit heretofore filed in this effice dated ...... lt, t~t~: .... 2.7., ....1968. pursuant to which Building Permit No.. 402g .Z dated ...... ~~.5., ..... 19.68, was issued, and conforms to all of the require- merits ,of the applicable provisions of the law. The .occupancy f. or which this certificate is issued is .... &O~lUm~Ol:~..btm:L~smm. ~tl&lS:[R~ ...................................... The certificate is issued t,o . .~ A~lt ........................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... ~.,/... ( ............................. ......... { Inspector ~Ol~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? ~029 Z 'Permission is hereby granted to: ........ ,~o~d...L~e .................................................. .................. I~,t£ttlllk ........................................ to ...,,~;atl~..~e~...~le,l,e.. heraae.. &. aec,...~eale...(.,teeeRee~,,.¥., e,~e.), ................................ ot premises Iocoted ot .......... .~...~.......~..~.~....A..l~. ................................................................................ ..................................................... ~.t..t..t.~ ....... ~.,.X., ..................................................................... pursua:n$ to applicotion dated ..................... ~1i~.....~1[ ..................... , 19...~8, and opproved by the Building Inspector. Fee $....~a'.O~ ........... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ~ X 19...[~ Permit No ......................... ........................................ , ... Disapproved a/c -...~ ........... APPLICATION FOR BUILDING PER/~ ~ Date .... ........................... , .... 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 p~rt 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 {:or any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment {:or 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, Ordirmnces or Regulations, {:or 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 cod~.ousing code, ,~_[~lulations. "/ ~) ~' ................................. ~"~'.%.~.~..~...(.~ .~.....j....[.~...~..~..~.-~' ~ ~ ~ ................ (Signature of aP~t, or name, if a co~tion) ...... (Address of applicant) State whether applicant is owner, lessee_agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on will,ch prol~os~d work will be dl,~e. Map No.k-~ ......... .~. ........................ ,Lqt No.: ........................ Street and Number L,~. (c) .i..:J..ciL, tlt-~ ~o~ '~ ~ ..... ~- ............. 7 ....... '/ ........................................................ ~;~i;'i~'i,~' ...................................... 2. State existing use and ~cupanc~ ~remises and~t~de~ ~se and ~D~cy of p~o~ constr.~tion: a. Existing USe and ~cupanCy '~.,~.~ ...... ~..~..~..5.......~.....~.~.~....~.~.~.....~n.~,~.~-.[.:~.L.~..~:/~. b. Intended use and ~cupancy .......................................................................................................... ~. Nature of work (check which applicable): New Building ..... Addition .................. Alteration .................. Repair ................. Removal .................. Demolitian: ................. Other Work (Describe) ........................................ 4. Estimated Cos~ :..~.¢..0. ......... ~ ..................................... Fee .....~.'. ................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ...... ~ii .......................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ~ .................... 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .....(~...I ......................... Rear....,~... ................... Depth ..~.. .................. Height ...... ~. .......... Number of Stories ...-%... ............... ¢ .............................................. ~ ................................................. 9. Size of lot: Front ...... ..~...¢...O..'.. .......... Rear ....... ..~...~..~.. ................. Depth .......... ..~.../..¢ ............... 10. Date of Purchase .................................................... Name of Former Owner'S... ...................................................... 11. Zone or use district in which premises are situated ).~...~..s...~.~'..'..s..~ .............................................................................. 12. Does proposed construction vielate any zeroing law, ordinance or ~e~ulation:> ....~.. .......... .-/...~..~......I ............... 13. Name of Owner of premises ~...~?.r.~.....i.../~....~..~7 ...... Address ..j~..~.Mq.q.y..i..~i'~.'.~:F~.....~.~2'~o. '.~.~..~.'~.'.~ ~ -- h N~me of Architect ...................................................... Address ............... : ............................ P one No ..................... Nome of Contractor ............ ...~....~ ................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicote all set-b~ck dimensians from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. cou .......... ~.~.~.~.~.....~..~.~..~.X.~ .................................. being duly sworn, d~oses and says t~t he is the applicant 1 (Name of individual signipg applic~tion)~ above named. He is the ..... ~.~.~,% ...... / /~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly au~orized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the applica~n filed therewit~ Sworn to before me this ~ , / ~ { ~ '/ / ~ day of ~ ,19 ................ ....... ..................... , .............. ....... ....................................... Notaw PublicZ.~~....~,.~~County ~_ (Signature of applicant) u~m~ ~. RECEN~ ' (/ NOTARY pUBLIC. State 0f New Yort Ho. 52-3233~20 Suffolk Coun~ Term Expires ~arc~ 30.