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Home My WebLink About279-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CEI~TIFICATE OF OCCUIPANCY THIS CERTIFIES that the building located at .S.~.}.~e~lte~e..]Ro~i...(~zreo~o~¥.. ~f~j~etyo~'k Map No ......................... Block No ......................... Lot No ................................................................... conformS substantially to the Application for Building Permit heretofore filed in this office doted .................. ...~..~.~.~....~.~ .................. , 19...~..~..., pursuant to wh,ch Building Permit No ........ J[..2."/.9 ....... doted ....................... ~J,J~..~b..~l, 4 ........... 19.Jj~.., wa.s issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................ ........................................... Il ....... lta.~A~l~ · · O11~ .. F~II~,~'. · ~~ ........................................... This certificate is issued to ~bleJ~,ta~t,..,~;[~j'J~.~.t...ol~r~ll~. ................................................................... (owner, lessee or tenant) of the aforesaid building. / BHiJding Inspector FOR4~[ N'O. :~ 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.° 279 Z Date ................ ~r~L:L..1..~. .................. ~9..5..8.. Permission is hereby granted to' Ja~u~.t..l~eter- .................................... ............... .~..11~.. it~h..8~ ........................ .............. lt~h~:ten ~ta, .... li,Y. ............. to .... ~__~.~l-"~w'- Idd~t~:ow'-ffor" het~rt~- ~pttn~ ¥--.to.-In..eat/l~,~I;lg.. .d~L~e ~'L~L~ ....... at premis&s Iocoted ot . 'l~/t~' 'l~[~'erL'~st~F~e"l~oI~ .................................................................. ............... i .................................................. fJ~eenpor t, .... .ll~-]f~ ..................................................... pursuant Jo apphcahon dated .............................. ~p~.~.~ ....... 3.~ ....... lC)..~'~., and approved by the Bu~Idln~ I.nspector Fee $'"~OO ........... Building Inspector ~ ' FORM NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. Examined .......... ~...(...~...... 19..~....~. Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ......~....~ ...... Application No. 'x.~-'~ ~/ (Building Inspector) t APPLICATION FOR BUILDING PERMIT .................... ...... ...... INSTRUCTIONS a. This application must be completely filled 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 o 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 Iterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ......... ......... .............................. YX i i;;;Z ' 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) 1. Location of land on which proposed work will be done. Map No: .................... ~T....'~'. ................ Lot No: .................... Street and Number Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. £xisting use and occupancy ..................... ..~. ......................................................................... b. Intended use and occupancy ................................................................................................................................ property lines. Give street and block numbers whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition ........ ~....Alteratlon .................... Repair .............. ~...Removal .................... Demolition ............ Other Work (Describe) 4. Estmated Cost ~..0.O' °'~ ~ ~'?~-~ .................... (to be paid on filing this 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 ........... c~......~. ...... Rear ....... ..~..~ ............. Depth ....~z'....[ ................... 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 ........... ~ ............. Depth ...~.. ....................... Height ............................ Number of Stories 10. Date of Purchase ........................................................ Name of Former Owne~j . 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, and indicate all set-back dimensions from or description according to deed, and show street names and indicate STATE OF NEW,,YO.P,~, e I£ ) S S COUNTY O~~.~r._.;) · ..................... ~~ ....... ..~..Z.~ ............ being duly sworn, deposes and says that he is the applicant (Nar~e of ind~idual 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 t~al~l~l~kcation are true to the ~st of his know e~ge and belief; and that the work will be performed in the ~nner ~:~ i~.the application f~ed therewith. ~ Sworn to before me this . ~ ~ ~ . f~~ ~ .............. ........ ............. Nota~ Public, ...~...~~..~-~...~n~_ ~ ~ ~