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Home My WebLink About3663-zFOI~M ~0. 4 TOW'N OF ~OUTHOLD 'I"OW'N CLERK'S OFFICE SOUTHOLD. N. Y. CERTIFICATE DF r'II:]EUPANCY THIS CERTIFIES that the building located atW/.~...Italian .l~ek. ~[~ane .... Street Map No...X.~. ......... Block No .... ~ ...... Lot No ~... ~.oe~nt~.. ~.~Y., .......... conforms substantially to the Applicati, on for Building Permit heretof, o~e filed in this ~ffice dated ........ .00t ..... ~ ....... 19.6.~. pursuant to which Building Permit No. dated ....... 00.~; ..... ~. ........ 19~., 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 ...P~i..V.a.~..e..o.~a .:[~r~ilY.. d~o~lin~ ......................................... The certificate is issued ~o ~.ohlY .&. ~4~rih~ .For~tino ........ 0~.~er.s ................ (owner, lessee or tenant) of the afore.said building. .Suffolk County Department of Health Approval .. 1~'~...~..l~..~y..1~,..V.i~..~. · · ...... ..... Building Inspector House ~ 1~00 FOlt~ 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? 3663 Z Permission is hereby granted to: ..g~.t ,...er~e~JA.....~lL./.~...~......~.~!~ Z, oat~ ................. ~'~~ .......................................... to ~ ~W 0~ ~'1~1~....~..~...e..~...~.....~. ...................................... L~ ~ ~lau Neck T~me ...................... at' premises located at ..../.! ............................................................................................... ......... ~..e.~.,.....~.,..~.: .... pursuc~t to application dated ............................ ~.o..t,.. ......... ~. ............ , 19.~..~...., and approved by the Building Inspector. S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date ~ 2 ? 1961] Bldg. Permit No. ~?/~ ~__ TO WHOM IT MAY CONCERN: at The sewage disposal facilities for a structure located (Give deed l~ocatioZn) have been inspected by this department and found to be satisfactory. District E~gineer District Engineer TOWN OF $OUT~OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~,C~,, ....~ .......... 19..~,.7. " " No3 Approved ........................................ ]9 ........ Permit ............................... Disapproved a/c ~ ............................. : ...... APPLICATION FOR BUILDING PERMIT Application No......~...~/~..~..~.. ......... 2' Z Date .................................... 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 location. 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 un~il a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanae 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 and regulations. .... ............................ (Signature of applicant, or name, if a corporation) (Addrds~ of applicant) / State wheth.er 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 aft ice r) '.~...~....~.......~.:~.:..~L~D/N~~/)~~.' 1. Location of land on which proposed work will be done. Map No: .... t Street and Number ...~..-=~m.....~..~...~..~.. ....................................... ~ ........................ : ............ Municipality 2. State existing use and occupancy of premises and intended use end occupancy of proposed construction: o. Existing use and occupancy ........ .0.~...~.... .................................................................................... b. Intended use and occupancy ....... '~ '~~...~.¥......~.,~,~,~.~..~..~....~..~¢¢......'~. ............. 3. Na(ure of work (check which applicable): New Building ............... Addition .................... Alteration ................ Re~oir .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. '[ z (to be paid on filing this application) 5. If cjwelling, number of dwelling units .............. ~ ................ Number of dwelling units on each floor ........................ / If garage, number of cars ........................................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ........................ 7. D~r~ens~ons of existing structures, if any: Front ............................ Rear ............................ Depth ...................... Height ............................ Number of Stories ........................................................................................................ Di~qensions of same structure with alterations or additions: Front ................................ Rear ........................... / De~)th .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........ .~/....?. ......... Rear ...... .7.....'~-. ........... Depth ~...,.~ ............. He~aht ............................ Number of Stories ............................ 11. Zone or use district in(-~vhich premises are situoted..~.~..~rr....~...L.~t.o > 0 ~ ...................... ]2. Debs! proposed construction violate any zoning law, ordinancer,or regula ',n ................................................ No'me of Architect ...................................................... Address ............................................ Phone NO ............... PLOT DIAGRAM Loca:te clearly end distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f property ines. Give street and block numbers or description according to deed, end show street names and indic whether ~terior or corner lot. ~r-vf STATE CF NEW YORK, ) S S. COUNTY OF ............................ ) be na duly sworn, deposes and says that he is the applk ,(Name of ir~ signing apphcation),,.~ ,~ above na,'ned. He is the .................. '.~...~.......~ ~ (Contractor, agent, corporate officer, etc.) of said o,net or owners, and is duly authorized to perform or have performed the said work and to make and this appl cation; that all statements contained in this application are true to the best of his knowledge and be and that the work will be performed in the~t~'l~l~ort, h. in the application filed therew_ithx-~ Sworn to beforec me this /'~ .9--~NOT^RY pUBLIC, State of Hew ¥or~~10. oS~.OE6x~.S[OsO ~cu~,~.~n~,~ (~ ~,~.~. ,,..~ (~')o"~~-'~' '" plre ~ ............. ~ ......... day of....~ .......... ~ ...... .~.;..-~' ~ (Signature of applicant)