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Home My WebLink About233-zI~OR1K 1~O. 4 TOWN OF SOUTHOI'.D BUI'L, DING D~--PARTMF,.NT 'IOWN CI..£P,.K'S OFFICF- SOUTHOLD, N. Y. C£tlTIFICAT£ Ol~ OCCUPANCY THIS CERTIFIES that the building located at ~.l:ltrld. ~tt~dJ~e R.o~d. S~eet Map No. ,,~ .... Block No ..... *.~ . Lot No conforms substantially to the Application for Building Pa,mit heretofore filed in this office dated ~ 7 ....... l~.O .. pursuant to which Building Permit No .......... dated ......... ~e~..J .... l~a .... was issued, and conforms to an of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is .. ............................ This eertlfieate is issued to ............ El~..~a~n~{...~e~ ......... (owner, lessee or tenant) of the aforesaid building. Bmldin~ ............. N.o Per TOWN OF $O~THOLD BUILDING DEPARTMENT TOWN CLERICS OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 233 Z Date ................. ]ill~e]~..~ ............. 19..~L ~ission is hereby granted to' to ..ttu~ Ltt.."~..luJid~.t;iozLt~..~-~ ~tiz~..dvsll_tns .......................................................... at premi,~es Iocated ct .ttz'~a~..&Ve.~&..lltLddlLe. ~ .................................................... ............. i ................................... ~t'Itueks...l~*~t* .................................................................... pursuantJ to apphcation dated .................. Jl{~l~]:l. ~r. ........................... 19..~.., and approved by the BuHdmg Inspector Fee $...~,,.(~0 ............ FO~,M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ...... 2../..(.~.~..."l ............ 19..~...~. Approved ................... :&. ................. 19....'.:..Permit No. '~ ~"~'~ ~.A Disapproved a/c .............................................................................................. ..................... ; ..................... ~.~ ......................................... Z.:~..i ...................... ...................... 'i ...................... /' ........ Application No ............................. APPLICATION FOR BUILDING PERMIT m,-- ' -') ,'-~ Date...:'...:.:.~' ..~...~ ................................. 19. .......... INSTRUCTIONS a. This application must be completely 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 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 a 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 purpose whatever until o 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 buildi.ngs, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance~ a~d regulations. · · "/~"~" /'t ,,-"m /~ , .................................. ,(Signa ure of applicant, or~ame, if a corporation) ,,, , ,-5 . ~ ~' ~/~cires, of o[~l~'icont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · ,m,, -~ ·-r. ~. , Name of owner of premises :):. ....... ~.,~~ .................................................................. 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 do~_e. M~p No: ............. .; ............................. LotNo; .......... ,~ ........ ' %,/z/' L ~..~, ,'~ '~ Street and Number ~:~~:.....;*.~ [&.:..%...--.~.~....2 ............... ~~~ .... ~unicip~li~ State existing use and occupancy ~ premises o~d intended use and occupancy o¢ proposed construction o.d .................................................................................................... b. Intended use and occupancy ~ ~.~ ........................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... terat on Repair .................... Removal .................... Demolition .............. ~ther 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. 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 ...... ~.~ ............. Dimensions of sa~tructure with alterations or additions: Front ......... ~.~ ......... Rear .......... ~ .......... 8. Dimensions of enfi~- new construction: Front...~.~l ...... Rear .....~...~..~....t .... Depth .~.Zt~.Z ............ 10. Date of Purchase ........................................................ ~ame of Former ~ner ........................................................ 1]. Zone or use district in which premises are situated.~.....~..x ............................................................... 13. Name of Owner of pr~..~,~.~~<~ddress ~~~ ......... Phone NO ....... : ............. Name 0f Contract~~~:..Address~~~ .......... N ... ............... / PLOT DIAG~M 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. kTE Of NEVi' YOR~,, /)... ) S S a b~o~~~ ~. '. '.~.'~.'. ~' i'beIng duly swOrn' dep°ses °nd says that he Is the applicant [ ........... (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 are true_..tto the best of his knowledge and belief; and that the work will be performed in the manner set forth in t~s~p~J~ed therewith. Sworn to before me this .- ,.~ ~ ~' ~ot~ ~ ~/ .... ~.~ ...... d of ~..~..; ......... b.. 19.~ ....... ,o,~;,,~ ~a~ure of applicpnt)