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Home My WebLink About3565-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. EIEI~TIFII~.ATE OF OOOUPANP, Y THIS CERTIFIES that the building located at ...8~ · .i~ll~lali8 .~a}at[.. · Street Map No..lgl[ .... Block No.. lt~ ........ Lot No.llj~... ~1'~.~1~.~ -1[~'~'~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... 11~15~, .... 9 , 19. ~}7 pursuant to which Building Permit No...3~ dated ............ ~8~.. ~., 19..67, was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is . .l~l~,~. Olle. t'at~..~ .c]~eJ~lil:g ...................................... The certificate is issued to .. ~,~t~rl. l~,Jb!e¢,~ ........ ~lr ..................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ....... II. 1~ ........................ ' ~ -Building Inspector FORi~I 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 FULL COMPLETION OF THE WORK AUTHORIZED) N? 3565 Z Permission is herebY/grcnted to: at prem sas located at ....... ~.,~ ..................................................................................... .... : ............................ ,...i-::,.~..L~..~**Z~..~~. ........ ~ .......... ; ............................................................... pursucn¢ to application dated ..; ........................ ~i~.......~.L .............. , 17.~.., and approved by the Building Inspector. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ×am,ned ............. Approved ........................................ ~ 19 ........ ~ermit ~o ............................. Disapproved a/c ........................ ..............................., ................................. ~P~I~TIO~ ~OR 8Hl~l~ ~8~IT 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 premi.ses or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of thb application. c. The work covered by this application may not be commenced before issuc.nce 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. APPLICATION 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, Ordinances 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 regulati~r~s. ........ .... ..................... (Signat~/~ of applicant, or nome, if a corporation) ........................ ....... ........... (Address of applicant) U State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~?~~..~...'......~:~.~....~?.: ..................................................... 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 '. ....... ........... Street and Number ............................................................... Municipality 2. State existing use and occupancy of pre~J~es and intended use and occupancy of proposed construction: a. Existing use and occupancy ~'~-'~ ~ b. Intended use and occupancy ...... ~...c ............................................................... J 3. NatUre of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) (to be paid on filing this application) 5. If d~velling, number of dwelling units ............................ Number of dwelling units on each floor If g~rage, number of cars ........... Z .................................................................................. 6. If b[usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dim!ensions of existing structures, if any'. Front ........ ~./. ..............Rear ...... ~../. .................... Depth Height Number of Stories ........ {... Dim~ensions of same structure with alterations or additions: Front ........ ~. ........................ Rear 8. Dim!ensions of entire new construction: Front .......... .'.,~'...Z..! ............... Rear ..... ..~...~..~ ............ Depth / 9. Sizei of lot: Front ....... }..~..~..~ ......... Rear ........../...~. .................... Depth 10. Date of Purchase ........................................................Name of Former Owner 11. Zor e or use district in which premises are situated ..... ~..: ....................... ..~.. 12. Doe proposed construction violate any zonlng law, ordinance or~ ,,~ -,~regulati°n? ...'.~ ................... Nar ~e of Architect ....................................... ,0 ............ Address Phone No. Nanhe of Contractor .}.~.. .Address Phone J ~/ PLOT DIAGRAM Locat~ clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-back dimensions fr property li'nes. Give street and block number or description according to deed, and show street names and indic, whether in :enor or corner lot. STA-r'E OF NEW YO Name of individual signing application) (Contractor, agent, corporate officer, etc.) of said ortner or owners, and is duly authorized to perform or h'ave performed the said work and to make and this application; that oil statements contained in this application are true to the best of his knowledge and belief; that the w~ork will be performed in the manner set forth in the application filed therewith. Sworn to I:Jefore me this Notary P~blic, ..~./.'.~.~.~.,.~.~)~j~.F:.lf,~G,Cj~nty ~(Signature of applicant) j ~/ /~/~/ NOTARY PUBLIC, State of Ne~w Yor~ ~ No. 52-7267800 Suffolk CountE, i Term Expire~ March 30, 196~