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Home My WebLink About3661-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY ~..O..m~.. ~rbor Lane THIS CERTIFIES that the building located at ~.~. ~.l'~l~&~;.~ .~d. ~ S~eet Map No. ~ ......... Block No. ~ ......... Lot No...~ ...... ~9~,..~ ....... conforms substantially to the Applicati.on for Building Permit hereto~e fil~ in this office dated ........... O~toh~r...9., 19.6~ pursuant to which Building Permit No...~. ~ dated ......... ~C~$~b~l~.. ~.., 19~., was issued, and conforms to all of the require- men~ .of the applicable provisions of the law. The ~cupancy ~or which this ce~ificate is ........................................... The ce~ificate is issued ~o ~.~P.q~ ................... ~ ....................... (owner, lessee or tenant) of the ~oresaid building. ,Suffolk County Department of Health App,roval .~P~..~ ~.. ~ 9.67...by..R ~..~la ...... FO]I{~ NO. 2 TOWN O~ SOU?HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N? Permission is hereby granted to: ~,..~...~..~..~.....~....~.~,~ ~.t:.~zt..~.,~. ...................................... (THIS PERMIT MUST BE KEPT ON THE PREMISES UNi:"I~- FuLL COMPLETION OP THE WORK AUTHORIZED) ...................................... ~out~14~..:fi~. .................................... ~ ................................................... .............................................. ~,..~.~...~; ........................... : ..................................................................... pursuon¢ to application dated ............. ~..,,~..-5~.~ ......... , 19 .., and approv~ by the Budding Inspector. ;~X~,~:. ~;~. ~-,, ~ g Inspector ~' . $-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da.Ce 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. District Engineer FOI~itl NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOV~N CLERK'S OFFICE SOUTHOLD, N. Y. ...... ..7.. .......... '9 /' ,,,,,,/ z- ~ Approved ....................... f~ ............... , 19..'.~... Permit No..~.~...~.L~ Application No. ~.'.~i.~i..~ ............ APPLICATION FOR BUILDING PERMIT Date .......................... 0.¢.t:;.abalL...9 .......... , 19.6~/. ...... 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 sh.oll be occupied or used in whole or in part for any purpose whatever until o 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. (Signature of applicant, or name, if a corporation) Mattit~e~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ............................................. .0..9.I1~?..a..?,.~ P..~ ............................................................................................................................ 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.: ...:1~ ............................. Lot No.:~ ................. Street and Number .~..~,gi~Z..[,*.0.,.~.*...~..~/.~..~.~..~P~..~,~.~ ....... ~.~.~p.~. ............... Munici~lity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... .}T~9.~I~..~,~ .................................................................................................. b. Intended use and occupancy ....... 9.~!~...~:~-]~...~}~:]:~ ............................................................................ 3. Natlure of work (check which applicable): New Building .,1l:~ ......... Addition .................. Alteration Rephir .................. Removal .................. Demolition .................. Other Work (Describe) .10.,.0.0. ................................................ 4. Esti~nated, Cost ,.~i9.001~ ............. .~. .......................... Fee (to be paid on filing this application) 5. If cjwelling, number of dwelling units ....~ ................ Number of dwelling units on each floor / f garage, number of cars 6. If ,business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dirr~ensions of existing structures, if any: Front ............................ Rear ................................ Depth Hei'Jght ........................ Number of Stories DJn~ensions of same structure with alterations or additions: Front ....................................Rear / De~th ................................ Height ............................ Number of Stories ................................ 8. DiMensions of entire new construction: Front .............. ~ ................. Rear ....... .~.0 ................ Depth ..~.~'x,~. ........ Hei,bht .................... Number of Stories .......... :L~ ............... 9. Sizq of lot: Front ....~,:20...~. ........... Rear ....... .:[2.0...'I~ ................ Depth ...... ~8.0..~ .............. 10. Dot? of Purchase ........................................................ Name of Former Owner ............ J)~,~,~...~ .................... 11. Zode or use district in which premises are situated ..*.~..A..!!...8,...&.~.t¢. 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ............. J~l~. .................................... 13. Na~e of Owne~ of premises .~.~,~.~.~n~.~l'. ................... Address ............................................ Phone No. No,ne of Architect ...................................................... Address ............................................ Phone No. Narlne of Contractor .~..~e:L]..~...~C..~.O~..,TJC~...Address ...~e.~.tJ.~l~¢l~ ................... Phone No. propert PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions Give street and block number or description according to deed, and show street names and or corner lot. STATE O1~ NEW YORK 1 ¢ c COUNTY OF ...~&~t'f.o~L]~: ............J"~"~' ................................. ~f~ 2/r¢..~1¢,..H~i ~L]o~r. ............................... bei n'g l(Name of individual signing application) abaw.~ ' Contractor no?ed. He is the of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ork will be performed in the manner set forth in the application filed therewith. Sworn to I~efore me this ................J,...~... day off, ................ .g,~,t,¢l~,~.~' .......... , ]~_,~ ~, fi N No 52.3233120 ~u?~ ~2"~ ~erm E~plres ~arch ~0, l~ duly sworn, deposes and says that he is the appli¢ (Contractor, agent, corporate officer, etc.)