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Home My WebLink About404-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL'ERK'S OFFICE SOUTHOLD, N. Y, CERTIFICATE OF OCCUPANCY No .......Z...997. .... Date ...................... Ja~ua~]~...19 ............19-61 CERTIFIES that the building located all~.t.,...~Rdl,.~...Calllp..M.tlle{~ia,~c~,~ THIS Map No ............**~.... Block No ...... .**.,. .......... Lot No ......,.*.~ ........................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................. AUkS-i:...2 ............. 10SS... pursuant to which Building Permit No ....... dated ............... AtlgUS{:'"5 .............. 1958.., 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 ................................ PRIVATIg...OI~.. ~'A~L~..D~L~ING .................................................. This certificate is issued to .......... F~enl?~....W,...E~.onn,...~ner ............................................ (owner, lessee or tenant) of the aforesaid building. FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE · $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST I~E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 404, Z Date Permission is hereby granted to: pursuant to application dated ................................... ~g]~.~...~. ......... 19.~'~..., and approved by the Building Inspector Fee $ ~.,.O.O......pai.~ Building Inspector 1~0~4[ NO, 1 TOWN OF SOUTHOLD BUILDING DEPART/RENT TOWN CLERK'S OFFICE SOUTNOL , N. v. ....... Approved ........................................ 19 ........ Perm t No ............................... Disapproved a/c.,..~, ........ ~. ............ ~ ............~ ............ >~ ........ ~ , -- .............. .............. [ ................. Application No ............ :.,.~ ............ APPLICATION FOR BUILDING PERMIT Date ..................... .............. ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building I nspecto'r. 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 e 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 far any purpose whatever until ~ Certificat, e of Occupancy shall have been granted by the Building Inspector. APPLICATION tS HEREBY MADE to the Building Department for the issuonoe 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable lows, ordinances and regulations. (Signatu~u~'of applicant, or name, if a corporation) : ,..?.. ~. ~ (Addr~s of apRlicant)..~..~ ~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be dane. Map No: ............................................ Lot No: .................... Street end Number ........... ,.,~ ...... ~-.. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existln~ use end occupancy .................................................................... b. Intended use and occupancy ............................~ ............................................................................... ...... .,ch applicable): New Building .................... Addition .................... Alteration .......... '. ......... Repair ....................Removal .................... Demolition .................... Other Work (Describe) .,~...-~ 4. Estimated Cost ........... ,~.......,- ......................................... 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. l¢ 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 some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions o~ entire new construction: Front ............ ./,...~.., ....... Rear ..... ;.~....,~,,. ............ Depth ,....~...o, .................. Height ~ Number of Stories .................... I::~ ~' 9. Size of lot: Front ....... /.Oo Rear ....... ~..,,O,.¢ ............ Depth ...... x~. ............ ~. .... }0, Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... .~. ...................................... 13. Name of Owner of premises ........................................ Address ............................................ Phone NO Name of Architect ........................................................Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and shaw street names and indicate whether inferior or corner lot. STATE OF NEW YORK, ) S S, ,~2¢OU NTY OF ............................ ) ¢/~¢..,~...~. , ..~ ~/'~,E¢~'? .~..~,...being duly sworn, deposes and says that he is the applicant ~ (Name or indiviouo~ signing appdcadon~ ~ ¢ (Cont~ctor, agent, c~rporate 9ff,cer,~t~ . . of said owner or owners, and is duly authorized to perform or have performed the sa~d work and to mal~e and file this application; that all statements contained in t~is application are true to the best of his knowledge and belief; and that the work will be performed in the ~ f~[~h in the application filed therewith, Sworn to ~efore me this