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Home My WebLink About3429-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,, N. ¥. CERTIFICATE OF oP.P. UPANDY No. Z 291~+ Date . 0c.tp.ber.. f:7., 19..6.7 THIS CERTIFIES that the building located at . 1//$ 01d I~ortk Roc~l Street Map No. ~ Block Bio. :X:x Lot No. ~ .SgB. t.h.q.I.d...N,.Y.: ....... conforms substantially to the Application for Building Permit heretofore fried in this office dated April 10 , 19 67 pursuant to which Building Permit No. 3~29 Z dated April ~t , 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 Pri,va~;e olle. S. am~tlS: .dweJ. tir~g .................................... The certificate is issued to Corir~e D~'~aporia ...... 0'~r~e~ ...................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval 0el; 26....1967., .by, .R.o..V..i.t.l.a.. Building Inspectort 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) Permission is hereby granted to: .... ~L~l~m..l~, .. ,~Lt~..~/~.. ~a~ ..i~,. i~J~j~l~ at premises located at ....................... gL~,l~.Jl~e'~..J.~,..~JJglJ~JJ~...~lJ~ ..................... pursuant to application dated ......................... ~l, Ji~Z,~,J...,L(J ............... , 19..tJ~.., and approved by the Building Inspector. Fee $.. ~LI~.J)~I ......... · FORM NO. ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN GLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ......... Approved ........................................ , 19..['. .... Permit No ..... ~ Application No..,~.~/~..~ .......... APPL,CAT,ON "U'LD'NG PE, ,T Do~te_ ..................... , "~ ./..,~_. --~' / 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 I~otion of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is ~:rt of this application. c. The work covered by this application may not be commenced before issuonce of Building Permit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit shall be kept on the premises ~vailable for inspection throughout the pr~r~s of the work. e. No building s~ll be occupied or used in w~ole or in part for any purpose whatever until a Certificate of Occupancy shall hove been granted by the Building Inspector; . APPLICATION IS HEREBY MADE to the Building Deportment for t~e ~issuonce of o Building Permit pursuant to t~e Building Zone Ordinance of the Town of Southold, Suffolk Count, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os ~erein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulat~~~ ~ ........ .............. ....................... State whether applicant is owner, lessee, agent,.orchitedt~ engiheer, generah contractor, electrician, plumber or builder· Name of If applicant is a corporate, signature of duly aulthorized officer, i (Name and title of corpar~te olfffc~r) · ~ ' ~ 1. Location of land on which proposed work will be done. Map No.: ...... ~ ........... ~,: ................ Lot No.: ..'~ ..................... Street and Number ...~f.~....~...~.~,., ............... (!~--~~........~....'....~...:. .......... Municipalit~ 2. State existing use and occupancy of premi)es and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .~....~.~ ......................................................................................... b. Intended use and occupancy ........... ~~ .......................................................................... 3. Nature of work (check which applicable): New Building ..... .4C......... Addition .................. Alteration .................. Repair .................. I~moval ..................Demolition .................. Other Work (Describe) ........................................ ~..¢...~ 4. Estimated Cost .......... /...(2,..c~..~...~.. .......................... ~Fee ............ ............................................................... (to be paid on filing this application) 5. If dwelling, 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: Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~..'~... ................ Rear ....~...~... ........... Depth ......~....~.. ........... Height ...../...q.~.. ....... Number of Stories ............/. ..................................................................................................... 9. Size of lot: Front ......../..~..~..~..T~.. Rear ...... ~....~...?.~..Z ......... Depth ...~...~..~.~..?..~.......--~.. -~ / ~ , ~3/~ 10. Date of Purchase ..... ../..~..~.~. ..................................... Name of Former Owner ........................................................ 11. Zone or use district Jn which premises are situated ..................................................................................................... 12. Name of Owner of premises~:..~.....~..~.Address ............................................ Phone No ..................... Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ 13. Name of Architect ........ .'. ................... : ........................ Address ........................................... Phone No ..................... Name of Contractor~...s...~..'...~ ........... Address .~ ............... Phone No."~....~.~.~...?..'7.~.~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set,back dimensions from property lines. Give street ond block number or description according to deed, and show street names and indicate whether interior or comer lot. J STATE OF N~OR~ ~ t c c ~ COUN~~~ Z~~~~-~~ ........... 5~'~' "' /" ................. ...... (Name of individual sig~ing application) above named. He is the .......... ~ ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the ~lication filed therewith. Sworn to before me this ........... ~ ~ ,~ Notary (Signature of applicant) S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Da.re Bldg. Permit No. TO WHOM IT MAY CONCERN: The sewage disp_psal facilities for a/Z~tructu~e located (Give deed location) have been inspected by this department and found to be satisfactory.