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Home My WebLink About4250-z~0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Occupancy No. Z. ~.~,a'~ ..... Date ............ ~.~3.~'...~9 ....... , 19 THIS CERTIFIES that the building located at ..... ]~]S .NEW..St~'fo~k. 1~ Street Map No.. ~ ........ Block No... ~ ..... Lot No..~ ..... Ott~C~kQgUe...t~,][.,. .... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... Apr.~l...17, 196.~. pursuant to which Building Permit No .... dated .......... ~,P~I .... !~., 19[19., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for ~wh~ch this certificate is issued is .... ~%O.~ag8. ~i~:~d.~.r~ ................................................. The certificate is issued to . Ul"d:%ed. ~il'e- Co .~..~ · .~. u~ehofltle. F.i.~e. (owner, l~essee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .... N,B, ............................ Building Inspector TOWN O~ $OUTSOLD 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? 350 z to at premises located at ............................................................................................................................ ....................................................... ~...., 19.E~.~ ond opprov~ by the pursuan,t to application dated / ~ /4 T~ ~ ~ ' Building Inspector. Fee $ ........................ Building Inspector ~FORM ,NO. I TOWN OF SOIF/'HOLD BUILDING D~PAR~'T'ft~,NT TOWIq CT-~K'S OFFIC~ SoIFrHOLD. N. Y. Examined..'. ...... Application No ................. Disapproved (Building Inspector) APPLICATIO~ FOR BO,t'-DING PERMIT INSTRUC-iiONS a. This application must be completely filled in by typewriter or in ink and su~bmitted in duplicate to the Building Inspector. b. PI~ plan ~o~ng ~cation of ~ and ~ buildings on premix, ~lat~ip W a~oining p~mi~ ~ public s~ets ~ ~, ~d giving a d~led desc~ption of layout of prepay must be drown On the dia~m which pa~ of ~ls applicatign. c.- ~ work ~ve~ by ~ applica~ may ~ be commenced before issuance of Building Pe~it. d. U~ ap~v~ of ~is applicator, the Building Inspe~r will ~sue a Bufl~g P~t ~ ~e applic~t. Su~ pe~it sh~ ~ kept ~ ~e p~mi~s available for ins~ throughout ~e p~ of ~e work. e. No building sh~l be occupied or u~ in whole 0ccu~cy ~1 ~ve ~n ~anl~ by the Building ~CA~ON IS ~Y M~E to ~e Building Departm~t f~ the issuan~ of a Build~g P~it p~uant to the Building ~ne Ordin~ce of the ~wn of ~thold, S~lk ~, New Y~k, ~d o~er a~li~ble ~ws, Or~nces or ~lat~ns, for the ~ion ~ build in~s, ~dit~s ~ alt~ations, ~. f~ ~v~,? de~ lition, as h~in descried. The applicant agrees W com ply with all .apphcable laws, ~l~nces, ouuamg ~e, h~sing c~e, ~d re~lations. (Si~na~e ~ app i a , , a ~ration) ~i~ao~ .. ~.~'.'~.~ '.. ~ ...... o ow= . ........................... ~orporate, si~ature of ~ a~lie~t ~ a dul~ author~e d ~fieer. (Name ~d title of co--ate officor~ b e done, ~ation of land whfeh p~ work will ~ ~ap No ............ ~ ....~t ~o .......... 1. on .... a. ~stm~' ' use ~ ~eup~e~~ ~... .... ....... :.:.. 3. .Nature of work (check which applicable): New Building ........ d iii,on ........ Alteration Repair ......... Re, l~pval ........ Demolitl, on ........ Other Work (Describe) ...................... (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. Dimensi, ons of existing structures, if any: Front .............. Rear ............. Depth ............. Height ................ Number of Stories ........................................................ Dimensions ,of same structure with alterations .or additi.ons: Front .............. Rear ............... Depth Height ~. ......... Number of Sberies ..................... 11. Zone .or use district in which premises are situated ......................... ,. .....~/~. ................ Does proposed construction ~xio,ta~ any ~;Tninghla.w, ,ordinance or gegulati.~0 ...... t~r~.~ ................. Name of Architect ..... . ...... .~ ................ .~dd ess ....... .~..~, .......... Ph~ne No ............ Name ,of Contractor ....... Address ._~X~ No. -- ~ ~ PLOT DIAGRAM L~cate c~e.arly and distinctly all buildings, whether existing .or p~oposed, and indicate all set-back dimensions from praperty lines. Give street and block number ,er deseripti~on acoording to deed, and sh~w ~treet names and indicate whether interior ,or corner 1,et. STA~ OF N~W YORI~, )S.S. COUNTY OF .............. ) cant above named. He is the ..~ ........................................................ .c~..~..~...... . (Contractor, agent, corporate officer, etc.) of said owner rer towners, and i.s duly authorized bo pe~rm o~ have performed the said w,erk and .to make .and file this applicati~on; that all statements contained in this applicati~n ave true to the bes{ of his knowledge and belief; .and that the v~c~rk will be perf~,rme,d in the mann er set forth* in the application filed therewith. Sworn to before me this ._~ 6z / --/~ Z-/< . N,*tary Public, .................... ~ounty ..... (Signture of applicant) ~LIZ~BETH~ . I. ANN NEVILLE No. 52.8125850, SuI[olk C0u~t,~ Term Expires Marclr 30, lgt~