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Home My WebLink About3388-zFORM NO. Zl- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE DF OCCUPANCY No. I 276t~.. Date .. . THIS CERTIFIES that the building located at ~/I~ 8Ot~4 ..~ Street Map No.II~s~;ez~ l~No.Sec ~ ...Lot No. ~2.13,! (~ee~l~O~...~,~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....... l~l~h...~ , 19/~7. pursuant to which Building Permit No. dated ........ :'E~h'" 3 ', 19 67 , 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~'~[¥at, e. o~e. £a~ily. d~;~?,?;~,r~g ................................ The certificate is issued to J~es Dl'egliol-zt ............ 0m~l, .................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval Building Inspector ~ FORM 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) No. 3388 Z Permission is hereby granted to: at premises located at ],Q~. ~,,~,~, ~.~Q~ J~[]:lO~e~ ............................................... ............................. fil~.uud..~Itl~.~ ....... G~.~a~.~r~..ll,X, ........................................................... pursuan¢ to application dated ................................ ~.a....~Z..h.. ....... .~. ....... , 19..~-?..., and approved by the Building Inspector. Fee $ ..~..0..,....0~.. ........... S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH D a t e ~/A~- ~g ~,/ Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located ,/ have been inspected by this department and found to be satisfactory. FO~M ~qO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, Iq. Y. .......... Approved ........................................ , 19 ........ Perm:t No ................................. Dzsapp roved ~.~...~- ....... ................................. Application No....~..?....~.......~.... .... APPLICATION FOR BUILDING PERMIT Date .... ~ ~...~..c..~.....3..!... ~..g. ?...Z. ........................ , 19 ........... INSTRUCTIONS a Th~s application must be completely filled in by typewnter or ~n ink and submitted mn duplicate to the Bu~Idinc Inspector. b. Plot plan showing location of Jot and of buildings on premises, relahonsh~p to adjoining premises or public streets o, areas, and g~wng a detailed description of layout of propertymust be drawn on the d~agram which is part of thins application c The work covered by th~s opphcat~on may not be commenced before issuance of Building Permit d. Upon approval of th~s application, the Building Inspector will mssue a Building Permit to the applicant. SucJ permit shall be kept on the premises available for inspection throughout the progress of the work. e No budding shall be occupied or used in whole or m part For any purpose whatever until a Certificate of Occupancy, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Department for the ~ssuance of a Building Permit pursuant to th: Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein descnbed The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of opphcant, or name, if a corporatmon) (Address of applicant) State whether applicant is owner, lessee, agent', architect, engineer, general contractor, electncian, plumber or builder ................ ............................................................................................................................................................ Name of owner of premises ........ ~T...a~..e...s.~.~D.~.e.~..h..~...:''n`.~...~.t.~.9.f:'n..1L.j~fL*.*..~P.~.~'~A~g~A~...~.~...~.~ ............... If applicant ~s a corporate, signature of duly authonzed officer (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No ]~astern ~hores Lot No: 121 Street and Number ..... ~.~Ll..rL~...~'.~l('.~.~....(~'~.~p~p.~.t..~....~.e...w...~.o.~ ................................................................... Mumcipality 2. State ex~sting use and occupancy of premises and intended use and occupancy of proposed construction: a Existing use and occupancy ........ .B..u..J....J:..d..~.~.g.....l:..o..t. ............................................................................................ b. Intended use and occupancy .. 3 Nature of work (check which applicable): New Budding ..... ~ .......... Addihon .................. Alteration ................. Repair .................... Removal .................... Demohtion .................... Other Work (Descnbe) .................................... 4. Est.mated Cost ........... .,~. .2: .5.. . ,. .0. .0. . .0. ... .............................. Fee ........................................................................................ (to be pa~d on filing this apphcation) ............................ Number of dwelling umts on each floor ...... ,o..,~..~ ............. 5 if dwelhng, number of dwelling units one If garage, number of cars ..... ..A..t.,t...~.c..h...e..d.....o...~..e. ........................................................................................................ 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use ....-.::.c .................... 7. D.mens~ons of existing structures, if any: Front .......................... Rear .......................... Depth .......................... Height ........................... Number of Stories ............................................................................................................. D~mens~ons of same structure w~th alterahons or aod t OhS Front ................................ Rear .............................. Depth ............................. Height ............................. Number of Stories ........................................ 8. D~mens~ons of entire new construct,on' Front ..... .b..8,..~...~.'.'. ......... Rear ...... .b..,8..]....~..'.'. ....... Depth .....3.$..~.,,.8,.]'. ........ Height ............................ Number of Stories .... ..o.,~..e.. ................ 9. S~ze of lot' Front .... .I..0...0...~ ............... Rear ..... ~.0.....+......-. ...... Depth ......3.,.O..Q...,+.....-. .......... 10. Date of Purchase ..... ~.~.~.u...a.~y...~.9...6..7., ...................... Name of Former Owner ..... .~..e,.~.IL~..~,~...~.]~fL[C;.~...~.Y.., .... 11 Zone or use district ~n which premises are situated ............................................................................................... 12. Does proposed construction wolate any Tatung law, ordinance or regulahon? .................................................... 13 Name of Owner of premises .~'..~..m,.e...s....~[.e.g.~...o.~..~. ..... Address ...p..o..~.t....~..a..s..b..~.q~,.t.p..t2 ..... Phone No. ~.Q...~...4..~; Name of Architect ....-. ................................................. Address ............................................ Phone No ................... Name of Contractor ..C.?.....~..-....?..9..~...e..]:~ ....................... Address ....G..z'...e.~p.~.g.~,t. .................... Phone No..4..?.7....9.9..9,. PLOT DIAGRAM Locate clearly and d~stinctly all buddings, whether ex~stmg or proposed, and indicate all set-back dimensions froi property hnes. G~ve street and block numbers or description according to deed, and show street names and mdmal whether interior or corner lot. Ira -t- STATE OF NEW YORK, 1 S.S. COUNTY OF ............................... .. ~~.z~¢.....~.~.~: ............................................. being duly sworn, deposes and says that he is the applic( (Name of individual slgmng application) above named. He ~s the .......... ~ ................................................................................................................. (Contractor, agent, corporate officer, otc ) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and thru application, that all statements contained in this application ore true to the best of his knowledge and beh and that the work wdl be performed in the manner set forth in the apphcation filed therewith. Sworn to before me th~s ......... .~ ............. doyof...,.-~C~.~j,,) ............. ' 19'"'~'"~7 ~ ....... ........................