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Home My WebLink About3581-zTOWN OF SOUTHOLD BUILDING DEPARTMENT '~"OWN CI~Ei~K'S OFFICE SOUTHOLD, N. Y. OEI~TIFIOATI~' OF' OOOUPANOY THIS CERTIFIES that the building located at .0~.~ .$h.l,]~J/'~$~ .~ ........ Street Map No ............. Block No ............. Lot No..8O~hO.~,: .~,.~ ,..~ .~OR~.~ conforms substan[ially to the Applicati.on for Building Permit heretofore filed in this office dated ... ~g~..~ .......... , 19. ~ pursuant to which Building Permit No. ~.~... dated ...A~gg~. ~4 .......... , 19.~7., was issued, and conforms to all of the require- ments ef the applicable provisions of the law. The .occupancy for which this certificate is The certificate is issued ~o ...~.~g$~.~...~$~ .................................. (owner, lessee or tenant) of the aforesaid building. -..~ .Suffolk County Department of Health Approval ...... ~.~'{..~.. ~J ....................... Building Inspector~ ~ FOF,~ 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) 3581 Z D~ ............................. ~,~,~.,,~;.~....., Permission is hereby granted to: ~ ' _ · ~.~.~.:..~..~ ~..~?.~.~.~...~..~..~..~.~ .... , ............... //~wt~h.o~t ......................................... to ~.~....~.~:.. g.~'~.V., ft.t,.ft..~:~, ~ ................................................................................................ at premises located at ,~d~.~..~.~[...~.~M~%~l. fl~.~..~i~b&~a~l ............................................................ .......... : ........ f~],~l..~l',~r.~l..l~e.~,.,....,~v,,t,~a ............................................ pursuam to application dated ......... ...; ........... ~..~r~.~ ......... .~.~. ............. , Buil~di'n'g Inspector : ,Fee $ ..... ; ................. ; 19~.~...., and approved by the FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. (Building I~ APPLICATION FOR~BUILDING PERMIT Date .......... ~......?..~.... ............... , 19~.~...... 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 deCailed description of layout of property must be drawn on the diagram which is pa.rt of thJ.s application. c. The work covered by this application may not be commenced before issue.ncc 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 ~gulations. ........... (Sig~ture o applicant, or name, if a corporation) ............ .................. /~¢'Z- / ¢zAf/~ /~c¢)/,,(~ ~J/ /cji ¢,-c-7 /~L,~ (ddressofapplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, siflnatuJ~r of duly g, uthorized officer. (Name and title of corporate officerY' 1. Location of land on which proposed y/ark will be done .~Map No.' ..................... .~ ............... Lot No.: ..~.~.?...~] ...... Street and Number ,~.~/~'~,/~~.~ ................. ~..~..../?....~...~. ............... 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 .....~,..~,.....~....~...C¢~d.r~.. ................................................................... 3. NatJ4re 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~elling, number of dwelling units ............................ Number of dwelling units on each floor 6. If I~usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Din~ensions of existing structures, if any: Front ............................ Rear ................................ Depth Height ........................ Number of Stories D~mens~ons of same structure with alterations or addictions: Front .................................... Rear D'e[th ................................ Height ............................ Number of Stories ................................ 8. Dinensions of entire new construction: Front. ......... .~.../~... .............. :.... Reor...../...~... ................ Depth Hei ht .../..]7~-. ......... Number of Stories ...L" 10. Dot of Purchase ........................................................ Name of Former Owner 1 t. Zon]e or use district in which premises are situated ...... 12. Doe~ proposed construction violate any zoning law, ordinance or reg~utotion? ...'~ ................... Nar ~e of Architect ..................... .~ .......... ~ ............... Address ........................................... Phone No, Nar ~e of Contracto : _ .Address . Phone No. PLOT DIAGRAM kocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines. Give street and block number or description according to deed, and show street names and whether in 'erior or corner lot. STATE OF NEW YORK, ~ c ~ ........................... ...~......~/......~?~....~...~....~C/..~. .......... being duly sworn, deposes and says that he is the applic Name of Individual si~ning appli above nerved. He is the ......................... , (Contractor, agent, corporate officer, etc.) of said or owners, and is duly authorized to perform or have performed the said work and to make and this ]Jion; that all statements contained in this appl'~cation are true to the best of his knowledge and belief; that the ~ ,rk will be performed in the manner set forth in the application filed therewith. Notary P~ ~'~, ] ~ (Signature of applicant) NOTARY No. 52-0618100