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Home My WebLink About3624-zTOWN OF SOUTHOLD BUILDING DEPARTMENT '~;'OWN CL~--I~K'S OFFICE SOUTHOLD, N. Y. CI~I~TIFIOATE OF OCCUPANCY No..Z..~.~.! .~ .... Date .............. ,,~111'~ .... 13 ...... , 19.68 THIS CEFtTIFIES that the building located at .]~151~(~%~;.& .C~l~t~ ./tlte .... Street Fairview Park Map No ............. Block No ............. Lot No. 12 ....... $O~/thO~.l~.t. .N,.~{~ ........ conforms substantially to the Application for Building Permit heretof~ore filed in this office dated ........ Sept ..... .~l+ .... , 1967. pursuant to which Building Permit No. ~(~1+. Z. dated ........ .Se.~t .... ~.1+. ..... 19.(~.~., was issued, and conforms to all of the require- me.nts o£ the .applicable provisions of the law. The ~occupancy for which this certificate is issued is ....PI'~va.t~ · one..f, amil~ ,dwe,~ t.img ....................................... The certificate is issued t,o ~:ICha~fl .& .Fram~es. ~addis ........ (~me~$.:: ......... (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Appzoval . l~y....~.1., · .~.958. · By. Re .V.tlta ..... Building Inspector FORM 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? 3624 Z Permission is hereby granted to: ......... ~..Cm.~i.~....a/~...~,el~,~..llm4~J & Wl£O to ]igC4.. ~te~...<ate... £~tlx ..~Xi~ ................................................................................... pursuan¢ to application dated ..................... ~J),t~....~l,~ ................... , 19...~., and approved by the Building Inspector. Fee $..~.~.e.~ ........... FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×o ,ned ..... ...... 1 Approved ........................ ............. , J. .Perm,t Disapproved o/c ...... ~.~ .~,~ ........ ~.....~..'...~.. ;~.~-- Application No......~...~....~.h.~... ....... APPLICATION FOR BUILDING PERMIT ...................... , 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 propertymust 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 o 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, os herein descri,bed. The applicant agrees to comply with all applicable laws, orc~ir~nces, building code an~.,re,e~/l~ions. ' .............. (Signature of applicant, or name, if a corporation) (Address of applicant) State wheth~M~ant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................... ................................................................................................................................ Name of owner of premlses .~ ..~......~......~.. ~.,.....~..~..~...~,-0 ~..~. ~..i ~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 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 premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... ~ ................................................................................................................... b. Intended use and occupancy ....... ~...~...~..~...~..~...~.~.~, ............................................................................. ReF 4. Esti 5. If 6. If 7. Di~ Hei Dir Def 8. Dir Hei 9. Siz, 10. Da' 11. Zo~ 12. Do~ 13. Na Na Na Loca' property whether STATE O COUNTY above na of said c this oppl and that Sworn to Notary ute of work (check which applicable): New Building .................. Addition .................. Alteration air .......... ~ ......... Removal .................... Demolition .............. : ..... Other Work (Describe) mated Cost ..........;; ........ ~..~..L~ ........ ~. ....................... Fee (to be paid on filing this application) welling, number of dwelling units ....... J .................... Number of dwelling units on each floor arage, number of cars )usJness, commercial or mixed occupancy, specify nature and extent of each type of use ~ensions of existing structures, if any: Front .......................... Rear .......................... Depth ght ............................ Number of Stories ~ensions of same structure with alterations or additions: Front ................................Rear th .............................. Height .............................. Number of Stories ........................................ ~ensions of entire new construction: Front ..... ~ ...... - ................ Rear ............................ Depth iht ............... ' ............. Number of Stories ............................ ~ of lot: Front ............. i.;. ........... Rear ......... '..' ................. Depth ......;..;'. ..................... e of Purchase ........................................................ Name of Former Owner ~e or use district in which premises are situated ............. ~ proposed construction violate any zoning law, ordinance or regulation? ~e of Owner of premises ........................................ Address ............................................ Phone No. ~e of Architect ...................................................... Address ............................................ Phone No. He of Contractor .(. ...... ! ...... .'.i.,'..;.;....: .................... Addres~ ............................................ Phone NO. PLOT DIAGRAM e clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimension.' nes. Give street and block numbers or description according to deed, and show street names and terior or corner lot, ...... ~.;~ ................................ .~ ................ ~em0 ~uW sworn, deposes ~nd says th*t he is tho oppl Name of individual signing~plicotjn~ ~ed. He is the .................................... (Contractor, agent, corporate officer, etc.) /net or owners, and is duly authorized to perform or have performed the said work and to make :ation; that all statements contained in this application are true to the best of his knowledge and the work will be performed in the manner set forth in the application filed therewith.' befgre me this ......... ......... , ' ~ ou applicant) $.~'A u ~ ,{~J ~ ' = ~ -¢?oo'r' -