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Home My WebLink About248-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDo N. Y. CERTIFICATE OF OCCUPANCY No... Z..743.. I~ate . . . THIS CERTIF!~S that the building located at ~O~/th~ .I~_~bo;g. ~. ~ ~olr~hO].~ Street Map No. ~ ......... Block No ..... ~... Lot No..~ .................... conforms substontially to the Application for Building Permit heretofore filed in this office dated .............. .Ma~..~...1.~ , 19~.8. pursuant to which Building Permit No .... S ..R.48 ~lated ................ Ma~:~ ~9,. , 19 ~4~ 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 This certificate is issued to of the aforesaid building. o'~me~ ................................ (owner, lessee or tenant) Building Inspector TOWN OF SOUTHOLD BUILDING DgPAR. TMENT TOWN CLEI~K'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS ~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. 248 Z Date ................ ~1~ 1~... 19..~.. Permission is hereby granted to; .... .~1~ .¥... ~'e~t.~..~l~k~, ................... · ~le~.t. Ta~_3..:l,~,.m.....~m~ton, ..... ~,~:., ....... to --ll~ e...a~ .a~te~att~n..-t~ .a~..e~vlt-~g. ~v~tt.~.r~ .................................................. pursuant', to application doted ................... ]~i,F4~....1.7. .......................19~..., and approved by the Budding }inspector ~uddmg inspector PLO? PL,~N ' FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............. /.....r. 4...v~...~.....l..J... 19....~.. Approved ................................................ ' No ............................... Disapproved o/c ~~ (Building Inspector) APPLICATION FOR BUILDING PERMIT D. "'~' ~ /"~' ,,.,~"*.~. a*~e ................... .,~....'......; .......... ~.. ............ ~ ........... INSTRUCTIONS a. This application must be completely fitled in by typewriter 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance 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 Iteratio/r~ or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ord i~ance~ rind recl'G~ations. ~~ame, if a~;~rporation) HO ' tvm OV mNTS, 434 West Jericho Turnpike State whether applicant is o~,n~, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ~..~. v~N.. '..~...~....L.¢~.. i~....~... ............. If applicant is a corporate, signature of duly a~orized officer. ~ (-'(Name and title of corporate officer) 1. Location of land on which proposed work will be done. MaD No: ............................................ lot No: .................... Street and Number ......... ~..~...~....~.......~.....~.;~....~.......~....c~/.. ....... ..~,..,z~ff,...~.?...~...~..Z .......................... . ............................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existlng use and occupancy ......... · .~..~..".~... · - .C. · .LJ:~....~. ,~.. ~'¢~'*'~.. · · !' · '~· .................................................................... b. Intended use and occupancy ............. ~ ................................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition ................. ,,~....Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) 4. Estimated Cost......|.~.;..-r~.. .............................................. 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 .............................. structures f an' Fr t ~-.'.~'.. 7. Dimensions of existing , y. on .......................Rear .....~..~.. ................ Depth ....D. .................... Height ...... ..~-......~... ........... Number of Stories ...... J ...................................................................................................... Dimensions of/~me structure with alterations or additions: Front .......... ?r..hJ(. ............... Rear .....~.....~... ................... Depth ........ ~.~ ................. Height ...... .~. ...................... Number of Stories ...L.!.....'~... ............... 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ......... .~..~. .............. Rear .......~.ff ................. Depth .J.?...C.Z. ............ 10. 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 prem ses i~."....~..~J.~. ~ ~.~...6..~...~.'../..~..Address~:~.~ ................ ,...~...~J Phone NO.~....g...~.-..~...~. ..... Name of Arch tect CERTIFIED HOME IMPROVEMENT~,, ~'~C. .................................................... ,'~aa ress ............................................ Phone NO. 434 West Jericho ~urnpl!~e ..................... Name of Contractor~est..F.~iib,..Huntiz~jte~.~..i..~..N,.¥,.Address ............................................ Phone NO/I~.~&}..'~/'~ PLOT DIAGRAM Locate clearly and distinctly ail 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. //- ~r' i STATE OF NEW YORK, ) S S. COUNTY OF ............................ ) .. ........................................................................................... ~e~ng duly sworn, deposes and says that he is the applicant (Name vidual signing 'apPlication) above named. He is the ~e,~J¢~,~ A~ , ................................................ ~'~i'r~;'~";~'nt"'j"~rpora"'""~e 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 applicatioh are tr~e to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the applico~herewith. Swgrn to before me this ~ ~. ~ .... :L..c7 ....... o, ........