The URL can be used to link to this page

Home My WebLink About106-zFOI~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....~/.~......~,~..~..~O..~.~...(.~.~.2~.). ............ Street Map No ..........~f2(~fX ............... Block No ............ Y~ ............ , ~'J( ...*~O~t.l;h~.~l.~......~.,:~'e conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... ~.~]0.t~f~m~..~k6.19...~-~., pursuant to which Building Permit No ...... .g.....]t..O? .......... , dated ............................ ~?~..~.......~..6. ......... 19~....., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ............ ...................................... ................................................................................... This certificate is issued to ......... ~.e...~.?..~...~...?..~..~..e..o..~ ............. (..o.~.e.~). ........................................... (owner, lessee or tenant) of the aforesaid building. 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 WITH ONE SET OF APPROVED PLANS AND SPECIFICATIONS UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) BuiJding inspector. Fee $.J...0.. ................. Building Inspector / POR~I NO. I v/ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam ned -~r~.....~..¢..... ] 9.~....?.. Approved ..................... k.~ ............... 19 ........ Permit No....~,(..~...C?. ........ ........... ....... ............ (Building Inspector) x Application No ....../....,.O....~ ......... APPLICATION FORIBUILDING PERMIT ~ Dote ~eRtember /6 1967 INSTRUCTIONS a. This application must be completely Filled in by typewriter or in ink and submitted in duplicate ta the Building Inspector. ' b. Plot plan showing location of lot and of buildings on premises, relationship to. adjoining premises or punic 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 appllcation may not be commenced before issuance 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 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 o Certificate of Occupancy shall have 6een granted by the Building Inspector. APPLICATION IS HERI~BY 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, as herein described. The dpplicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) P.0. Box 602 - Nai~ Road-8outhold,LoI., (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, ~lumber or builder. 0~NER Nome of owner of premises......g~.r~.~7...;~..~.~.e.t.~.~....ma~...~9.r..q.~.7...~.~.$.~......E~.~.Q~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. Mop No ................................... Block .................................. State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... It9.~.~ ......................... ....... occunancv oollstruo~ioB of 1~ story dwelling to bo ooeu ie b. Intended use and - ~ ~, ................................................................................................................ .l?.......a; ...... by o~e family 3. Nature of work (check which applicable): New Building .......... · .~r.~.'e,, ........ Add t on .................... Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ~ ~ Fee ...,~lo.,,t)~ ........................................................................ ....... ~/~'SO'~ ...................................... (to be paid on filing this application) FEES: 5. If dwelling, number of dwelling units .......... ~ ................ Number of dwelling units on each floor .......................... If garage, number of cars ........................................................................................................................................ 6. If business, commerical or mixed occupancy, specify nature and extent of each type of use ................................ 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 ......... .~2.~! ............ Depth .....;~0.~ ................. Height ...... 2'0~ ............... Number of Stories ..3,~- ..................... 9. Size of lot: Front ......... ~0.~ ............. Rear .............. ~0.~ ........ Depth .......... ]'[tO~ ......... 10. Zone or use district in which premises are situated ........ ~o~$~.et~.b&~.~...&..~[9~[e.u~.¢~t~3 .......................... 1 1. Does proposed construction violate any zoning I ordinance or regulation? .........n~ ...................................... 12. Nome of Owner of premises~]~r.q~.2E(~[~4;~.0. PJ[....Address .if~.i~8~.aW.8*~.~:~.~.~....Phone NO. 8~.~ ............ Name of ~c~it~t.;~.t~zzf. z~.d~.~i.~.d ................... Address ............................................ Phone NO. ~$~ ......... Name of Contracto~;.He.a~.~]:...O~.lo~s~l .............. Address~e.~,~.~Cm:~.c~u~f~one NO. 6.Z[~8 ............ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines· Give street and block numbers Or description according to deed, and show street names and indicate whether interior or corner lot. . ....... STATE OF NEWnYORK, ) COUNTY OF~....) S S.' (~ame of individual signing 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 make and file this application; that all statements contained in this application ore true to the best o~ his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn/~(_~to before me this '~"' N'etlry P~blic, 8~te of New YOA ~esiding Jn Suffolk Coun~ No, 52.0367800 My C0m~:~tt E>:pires ~larch 30, Ig (Singature of applicant)