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Home My WebLink About542-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, CERTIFICATE OF OCCUPAHCY THIS CERTIFrES that the building located at.~e~.t~...0~.~..JL~..f~.e.a...~.~.~..q.~.Q§..~..~ .... ~ Map No ..... ?..~.~.. ............ Block No ....... .?..??.. .......... Lot No ............ ~?.. ................................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................... Deo.e~be~...~. ............ , 19.~.~...., pursuant to which Building Permit No.....~....~.....~. ............. dated ........................... .])eo~b.e['...c~.., 19....~.~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. ..................................................... ~.~ ~AT~I..O.~;~A~ I L~.. ~.W E ~.~ ~.6. .......................................... This certificate is issued to .~a.1]~]~..~Qft_eb~l.&~...o.~.~),e,l~ ................................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspector Ho~ar~ M. Te~ry 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) N.° 542 z Permission is hereby granted to: ~, Beebe Date ................ ~ecea~r...~ ................. 19.~.~.. ~/G .... ~4a.1.1~t~..Ted®lmlh .................................. .......... ~le~..i~.£~l~..~a. .................................. ................ Outeh~te¥...-.lt,.¥., ........................... to .......... ~ui.~.d...mt..adc~i.t.s eh...o~ .- ea.-e~t~.t~l~., d~e .1.1..L~ ........................... : ................... at premises located at ..... ~..~,....¥/~ij.t~..~.l~e~k...&~ ......................................................................... ....................................................... C~toho&~e~.....1~,.¥,, ................................................................... pursuant to application dated ........................ JL~e~,e~,~ol'.....~ ............. 19..~.~., and approved by the Building Inspector Fee $.~.e~ ............. / Building Inspector FOBM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............ Application No.......~....~.......Z~.... ....... Approved ........................................ 19 ........ Permit No. Disapproved a/c ......................................... _ ..... APPLICATION FOR BUILDING PERMIT Date ........... ~ ....... ~ ....................... 19. ~..~.....~... INSTRUCTIONS o. This application must be completelv filled in by tVpewriter 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 o detoiTed 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 Buffding 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 port for any puFpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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 laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) State whether 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 officer) I. Location of land on which proposed work will be done. Map No: ..................... :: ........ ~ Lot No: .................... MuniciPality State existing use and occupancy of premises 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 .................... Addition ../~, .............. Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... ............... ~ ......... Number of dwelling units on each floor ............................ 6. If business, commercial or mixed occupancy, specify native and e~ent of each type of use .............................. structures, if any: Front ........... .Z/..~¢~...: ...... Rear ...... .~..//~ ........... Depth ...... ~.../~ .......... 7. Dimensions of existing Height ....... ,~..~. ............ Number of Stories ........... ~ ....................................................................................... Dimensions of sa/ne structure with alterations or additions: Front .......... ./....~.. ............. Rear ......... ~..~... .............. Depth ~ .~..... ....... He ght ............ l..~. ........... Number of Stories ...... /. ........................ -- Height ......./.~. ............. Number of Stories ....... ./... ................. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction/~aze]~~, ,ordinance~or regulation.;) ............. ~ ......................... Name of Architect .................... ~ ................ · ........... Address ............................................ Phone NO. Nome o Contractor .............. '~....~.....~...~......Address ............. /../. ........................... Phone NO. 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 NE~Y,O,RI~/~ ) S S COUNTY OF ~.C. ........ ) · (Name 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 hove performed the said work and to make and fife 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~,fortl~' in the application filed therewith. Sworn to before me this ,~ ,~::~ ... ~ , .................. ~ day. of .~~~ ..... ~9!!~...-~..,~-~,~'~;:;:, ~;.;?. ~." ~(Signature of applicant) Notary Public,