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Home My WebLink About3366-zFOP,~I~ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. P-E:RTIFICATE: OF OI::)CUPANnY No..~..2. ~.~.3 .... Date .................. ,J'~,..L~.,. ~.~ .... THIS CERTIFIES that the building located at ... W~tB..X$111~g~-l~O~ ........ Street Map No..~ ........ Block No.. 3~, ....... Lot No. :1~ ...... 01,~.~;..~,.'g. ............ conforms substantially to the Applicati.on for Building Permit heretofore filed in this office dated ........... ~..~1~1...19. .....19. [~ pursuant to which Building Permit No. '3-~ - dated ......... ~'all ...... ~.., 19.67., was issued, and conforms to all of the require- me.nts .of the applicable provisions of the law. The .occupancy f. or which this certificate is issued is .Pl'~.¥t~'~8. ozl~..J?~;i.~.~: .~.~4~l..~g .......................................... The certificate is issued to . .~/l~.l:[t~l~.~I']~].~n,..Jl'. .......... 0~1151, ................. (owner, lessee or tenant) of the afore.said building. Suffolk County Department of Health Appl~oval .. ~12... ~,..~6~ .. ~y. ~,. ~.~].~ .... FORM NO, ~- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3366 Z Permission is hereby granted to: ......... .~.o...n.7....~.o...r.~.....~g.....~...,....~r..k.~.~...j~ ................... O~t .............................................. to ..~lil~L./~w..nna..f~l~...~welling ................................................................................. at premises located at ....W/..~.....Yal~lg&..]~J ..................................................................... .................................................. (lrient ................................................................................................ pursuan¢ to application dated ..................... ~T~I~., ....... ~1,9. ................. , 19..~.., and approved by the Building Inspector. Fee $..lO.,O~ ......... Building Inspector S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ 2 5 Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located (Give deed location) have been inspected by this department and found to be satisfactory. Di~br~_ct ~ incer District Engineer FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ..................... (Buil~ APPLICATION FOR BUILDING PERMIT Date ............... ~ ..... /...~ ..... 19 ( ? INSTRUCTIONS Application No ...2.?.....~......~.... a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin. Inspector. b Plot plan showtng location of lot and of buddings on premises, relat,onship to odjoimng premises or pubhc streets c areas, and gwing a detailed description of layout of property must be drawn on the d~agram which is part of this applicatior c. The work covered by th~s application may not be commenced before issuance of Building Permit. d Upon approval of this application, the Building Inspector will ~ssue a Building Permit to the apphcant. Such perm, shall be kept on the pr. emises ava,lable 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 untd a Certificate of Occupanc shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances c Regulations, for the construction of buildings, additions or alterations, or for removal or demolihon, as herein descnbec The applicant agrees to comply with all applicable laws, ordinances, building code and regulations ... ................. .................................. (Signature/of apphcant, or name, ff a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engrneer, general contractor, electrician, plumber or buHde~ If apphcant is a corporate, signature of duly authonzed officer (Name and t~tle of corporate officer) 1 Location of land on which prop_osed work wdl be done .Map No .................... · ....Lot No ·. .................. Street and Number ........ ~.~.?...~..~ .... ~~ ...................... ....~...'?.~?.~..-.~.... ........ ..~./~'..~ ...... U ~/ Munlcipahty ~' 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction a Existing use and occupancy .................................................................................................................... b Intended use and occupancy ~..~ ~ 3. Nature of work (check which applicable): New Budding .... ...I;C~... ........ Addition .................. Alteration .................. Repair ................. .~,,~moval .................. Demolition .................. Other Work (Describe) ....................................... 4. Estimated Cost .....~..../....~....~...?...~.. ............................. Fee ......................................................................................... (to be paid on filing th~s apphcation) 5 If dwelling, number of dwelling units ~/ .... Number of dwelhng units on each floor If garage, number of cars .................................................................................................................................... 6. If business, commercml or mixed occupancy, specify nature and extent of each type of use .......................... 7. Dimensions of existing structures, Jf any: Front ........................Rear ................................ Depth ................... Height ........................ Number of Stones ............................................................................................................ D~mensions of same structure with alterations or additions Front .................................... Rear Depth .............................. Hmght ....................... Number of Stories .......................... 8 D,mensions of ent,re new construct,on. Front ..... .J'// .......................... Rear ..... .~....~.....~ ............ Depth ....~--2....~...~ ..... Height .....~....~.~...t. ..... Number of Stories .... ~ ...................................................................................... 9. Size of lot' Front ...... ./..~....O....~. ......... Rear ....... ../~..~. ' Depth / ~' ,'~ ' 10. Date of Purchase ...~ ...... ./..~....~....~.. .......... Nome of Former Owner ...... : .... ~ .................... 11 Zone or use &strict in which premises are s~tuated ...~'. ................................................. 13.Nome of Owner of premises~..'~...'.'....~..~.~ddress ./.?.....'~...~.~. ~Phone No .................. Name of Arch,tect Address . .~..~..~..... ~;~J~" ... Name of Contractor ~.....~)~...~./...4~. ......... Address .......~.'I.~i~...iiiii"ii Phone No~ ~'~ PLOT DIAGRAM Locate clearly and d~st~nctly all buildings, whether emsting or proposed, and mdmate all set-back dimensmns fron property hnes. G~ve street and block number or description according to deed, and show street names and in&cat. whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ..,~.~..~.~. .............. ......................... .................... (Name of indlwdual s~gmng apphcat~on) being duly sworn, deposes and says that he ~s the applicc above named He is the ............................ [,.~.~,.,~,~.~.,C.,Z~./~. ........................................................................................... (Contractor, agent, corporate officer, etc ) of said owner ar owners, and is duly authorized to perform or have performed the sa~d work and to make and [ th~s applicahon, that ail statements contained ~n thts application are true to the best of h~s knowledge and behef, a that the work will be performed in the manner set forth ~n the apphcation filed therewith. Sworn to before me this ....... .... .................. , ......... ......................... Notary Public, ~.~.<~-/~.. ~rf/.-~,~,My'~.;,'~.~¥~.I~,.V,.'?4G, ~unty /~/(S~gnature of apphcant) ~'~ ~" f./NOTARY PUBLIC, St,~tc, o! New York ~ No. 52-7267800 S~'foik ('ounty Totem Expires l~larch 30, 196~