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Home My WebLink About4128-zTOWN OF SoIFrHOLD BUILDING D~PARTMI~NT TOWN CL~RW"S OFFICI~ SOUTHOLD, N. Y. CE::I~,TIF'ICATE: O~' OCCUPANCY No. Z~ .3A96 .... Date ............ ~y ......... 2.'~,.., 196~. THIS CERTIFIES that the building located atRvi:o..Rd~, o~£. ,~ackmon .$~, Street Map No ............. Block No ............. Lot No. ~I~ .Sl~£fcllk,..ltI~ .y.~l~lr ....... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... ~Io.~e~aber...IA,..., 196l~. parsuant to which Building Permit No. 41~8. Z. dated .... ]~lL..14, .... , 19.68., was issued, and conforms to all of the require- merits of the .applicable provisions of the law. The occupancy for which this certificate is issued is .p;r.l¥i~i;~..Ol~..~i~;I.~.~.. ~llde~,l~ .......................................... The certificate is issued to . .lllh~Ofl~rloz:. Pq~Itf; .(l~l~p,.. l]~-. l~l~l,*.~. ]~OU~)... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......................................... Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: to .......... .~,1,~,...~.~..~:~ ~,tj,~...a~..~..~,d~.~.. ~t~m~ ............................................... at premises located at ............ ~..~...~.~.~lilg~h~..~..~. ............................................................. ....................... ~....ew....~.~£.e~l~ ......................................................................... pursuanrc to application dated .......................... ~O~. ......... .t~ ............ , 19...~, and approved by the Building Inspector. Fee $.~..*...0~.. ............. TOWN OF S~TH~D ~/~/~ ~ ~' TOWN CLERK'S ~FICE/ ~ ~' q ~'~" ~ ~UTH~D, N.Y. ~ ~'~' ~ ~ ~ ~' ) Ex,mined ~ / ~ lP..~.~ Applic~ti~ No ~ i ~ ~r ~proved '' , 19 ........ Permit No ............................ Di opp o .............. ..... (Buildi~ Ins~tor} APPLICATION FOR BUILDING PERMIT Date ...... ).~.~......./....~.. ...................... , 19...;~...~'~'' 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 a detailed description of layout of property must be drawn on the diagram which is part of this applica- tion. 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 ~ntil a Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS H.£REBY 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 opplicable Laws, Ordinances or Regulations for the construction of buildings, additions alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ..... ......... ............ ....................... 4',. -- (Addl~Iss of applicant)/ Stece whether appIican¢ is owner, lessee, agent, architect, engineer, §eneral contractor, e~ectricion, plumber or builder. ............................................ ................................................................................................................. If applicant is a, 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.: ........................................ Lot No.: ,P~'T 7-~r~.~ ~FI--- ...................... Street and Number ................... ~...~..~..,~....~.~..A~....~.......~....~..-....~..........O~....~..,,/~...~....~....~.....~ .......................................... Municipality 2. State existing use and occupancy of prern~ses and intended use and occupancy of proposed construction. a. Existing use and occupancy / F/~ ~'/ I l._~f' ~ L~/ /~ L~_I A/ ~- b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building. ................... Addition .................. Alteration .................. Repair .................. Remova! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost .../.'~....~...~.. .................................. Fee ...... i.i ............................................................................... (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 ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .................................... 7. Dimensions of,~st~ng structures, if any: Front .............. O.,~.zf... 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 .............................. Rear .............................. Depth .............................. Height .............................. Number of Stories .............................. 9. Size of lot: Front .............................. Rear ................................. Depth .............................. 10. Date of Purchase .......................................................... Na,m~ oF Fj~7-mer O~n~r_~..~.~..Z,..nx...-/./..x~.z_ ........................ 11. Zone or use district in which premises are situated ........................................................ ,~.~?. .................................... 12. Does proposed construction ~iplate any, z~r~ina !awzor~r~o,~ae or ren...Int n,> r, r, ~ ~-,~' ~I(/I'// ~-L- A (z,~ r ~.~ I'¢~' '~"t"~"'~"~'"~ ........................................ 13. Name of Owner of premi~'~/~_~..4.....~-.z~,.l~..~,:.C~.~.. Address .......................... Phone No ................... Name of Architect "'~"7"£'?' ....... Z"~':~'~t~'~',~f'"' Address ..........~.~,'..~.(..~.4.~.u.Z:T ...... Phone No ................... Name of Contractor .................................................. Address ................................................ Phone No .................. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. /~E V A'~' I'~ ,A/~'~- X~ . J STATE OF NEW YORK, ) COUNTY OF ............................ ) S.S. ...... ?'~'?'":~' m'~' '"~-~' .....~..z!,; ~'~ : · .~.,-..~ duly sworn, deposes and says that he is the applicant .... ~':~'4~ ....................... being~'~ '----'¢Name of ihdlvidi]l~l~St~t~ al~'[~a-'Tion) above named. He is the ......... ~"~:;,~r:-,~-~, ~-.. ~ of said owner or owners, and is duly authorized to perform or have performed agent, the corporate said work officer, and etc.) to make 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 forth in the application filed therewith. Sworn /...~......~..dayt° before me thi-~_._~ ,_ . ~. ~ .......... .... x-::/' / Notary Pub h c ~'~J~.. ~i~i~a t ~i~