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Home My WebLink About3617-zFORM TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANP. Y No, ~ .$0].? .... Date .... ~pr. tl. 4., ............... , 19 68. THIS CERTIFIES that the building located at RO~l;al~ ~ ll~ad .............. Street Map No.~[~[~U.. Block No ............. Lot No. t~a~t, a£. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...... ~.eP~:....$1 ...... , 19.6'/. pursuant to which Building Permit No.:~ .]6t./- dated ...... $.~.P.~t. ~ ........ ,19 .~.?., was issued, and conforms to all of the require* merits of the applicable provisions of the law. The occupancy for which this certificate is The certificate is issued to ........ 1'.~t.t;~. l~],~;::l~e~. ............................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ................................... Building Inspector FOl~I NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3617, Z Permission is hereby ~ranted to: ....~.,....~.,..~.~.L.,~L~...~gJ, t,L.~l.~ ...... .................... ~,~h.~... ......... ~ ............................ at P~emis~s I~ated at ..... ~..~.....~.Z~ .................... . ......................................... pursuant.to application dated CeD~ ~ 19.~.., and approv~ by, the BUilding ;Inspector~ ,, .Fee$...;; ................... FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................... :~ ................... , 19..!!.... Permit No.. ......... '~ ~/..........7 ........ ~ Application No. ,~7...~id.Z ............ (Build~r) APPLICATION FOR BUILDING PERMIT 19..~..~ Date J 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 detailed description of layout of property must be drawn on the diagram which is part of this application. 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 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 regulations. /~'~T l [:.,~I~X p~"J,~-~' ~u//O.d;,c7 }~LL:~ (Address'ofapplicant) ......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~...~..,.../...~.. ....... '~.....~..~..~.~t...~..& ............................................................................................... 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.: ......~....~..'~..~...~....~......~.t~..~?.~.~.."~Lot No.: ...f..L~..~.~ .......... Street and Number ................................................................................................................ ff ..... t ....... ' ........ Municipality 2. State existing use end occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ...~i~.~.~r..~../~. ....... i ................................................................ 10. 11. 12. 13. property lines. Give street and block number whether i,n~eriar or corner lot. Nature of work (check which applicable): New Building .................. Addition ....... '-. .......... Alteration Repjair .................. Removal .................. Demolition ...... ~ .......Other Work (Describe) (to be paid on filing this application) ff dwelling, number of dwelling units ............................ Number of dwelling units on each floor If )usiness, commercial or mixed occupancy, specify nature and extent of each type of use Di lensions of existing structures, if any: Front ........ ~.../ ................ Rear ......~../. ....................... Depth ~.~-' Height ........................ Number of Stories .../.. Din JensJons of same structure with alterations or additions: Front ........... ~ .................... Rear "-- De th ........... ..':rt.. ................. Height ........ .Ti.... ............... Number of Stories ...r. ........................... Dir~ensions of entire new construction: Front ........ /.(.: ...................... Rear ......... ~. ................. Depth Zo!e or use district in which premises are situated Do~s proposed construction violate any zoning law, ordinance or regulation? ...~'..~...~...~. ..................... No,ne of Architect ...................................................... Address ............................................ Phone No. PLOT DIAGRAM koca~e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions or description according to deed, and show street names and STATE O~ NEW YORK, ~ ~ ~ COUNTY OF ................................ ~'~' ................................................................................................. being duly sworn, deposes and says that he is the applk (Name of individual signing application) , above nat~ed. He is the ........................................................................................................ ~ (Contractor, agent, cSrporate officer, etc.) of said o~ner or owners, and is~duly authorized to perform or have performed the said work and to make and this appli :arian; that all statement~ contained in this application are true to the best of his knowledge and belief; that 'the ark will be performed in the manner set forth in the applicatbn flied therewith. Swam to~efore me this /) , ~ ~ ~2 ....................,/l day of ~ ~ , ................ ~..: ..... ~ILDRED OHAP~N ,~ // - // /I ~OTA [Y PUBLIC, State oi New ~or~ // 7 /~ Nc 52-0618]00 Suffolk Coun~,. - ~ ~omm~ ;~o~ Expires Marc)l 30, 19~