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Home My WebLink About288-z~OP~I[ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY 7H!S CERTIFIES that the building located at Map No. .e* Block N~ Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........ ~=~ ..2.~ , 195~ pursuant to which Building Permit No. 288 dated ..... ~t% 21 , 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 18SUed iS ...................... This certificate is issued to . ..~e[ ~=,. ~. ......................... (owner, lessee or tenant) of the alo~'esaid building. Building Inspector FO~ NO. ~ TOWN OJ: $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 288 Z Date ............. Ag~I:L ....~1 ............... ] 9.. ~.8. Permission is hereby granted to: ~/~a, l~,au~e ....A~.¢..~tJaei ..~,A,~e~ ........................ ............. llet. ttt~eie ii -1W.~.¥ ~ ......................... to --lh~L. td...a..~er~er...~..-e, ex~t~n~.-a~etl4.nt~ ....................................................... ct premises located at .-]litil~$Y~tl~l .... ~l%.tt~.~.t~lllE~..~r~.~ ...................................................... pursuan! to apphcat,on dated ................... ~t~.. ~,~ .................... 19.~..., and approved by the Building Inspector Fee $..~'~ ~ ............ Budding Inspector FOl~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. xam~nea ............ ~,.) ......................... ~ y.~'.... ,t it ~'~"'er' No~'-'~00~(~;~'. Approved ........................................ 19 ........ P m~t .............................. Disapproved a/c ..........~: ....... ""r:": ........ ........... Application No....,?...5. i....~... ........... (Building Inspector)~ APPLICATION FOR BUILDING PERMIT Date .................. ~..~.!. ........... ,9.....~'....?~.. INSTRUCTIONS o. 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 cov,ered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Bu, ilding 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 pui'pose 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) ...... ...... ............ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .............. ~ ......... ~ ...................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ............................................ Lot No: ,~'~ 2--,~ Street and ~ c,,...-, Q -- ~ ~JC~ /1./" ~ Number ........... ..~................ ........ ~ ........................................................ ~ ............... ; .................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: and occupancy __/t~...~ ~ ~ a. Existing use ......................................................... ;~....; ................................................................... b. Intended use and occupancy ................................ t~ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ..~ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .......... ..~....?... .......................................... Fee ....~......c~.. .............................................................................. (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 ....~..~ ................. Height ............ L....~.. ........ Number of Stories ........ .I. ................................................................................................... Dimensions of same structure with alterations or additions: Front ............ ..~.....~ ............ Rear ...~.....[ ...................... Depth ........~..~. ................. Height .../.~..~'.. .................... Number of Sto~es ................................ 8. Dimensions of entire new construction: Front ........... .~....~ .......... Rear ......... .~....~. ........... Depth ......... .?....?. .......... Height ............................ Number of Stories ......6~...~..:T .............. 9. Size of lot: Front ............... ~..~.... Rear .........~ ............Depth ............. .~....~.. 10. Date of Purchase ........................... : ............................ Name of Former Owner ..........~...: .......................................... 11. Zone or use district in which premises are situated ....... ~.....~-cg,,,,~...~.... ........................................... 12. Does proposed construct on voate any zonng aw, ordnance or reguaton? ......... ~ ..................................... 13. Name of Owner of premises...~...'~.......~...Address-~ '~ -- ....~..~~ .......... Phone NO ..................... Name of Architect ........................................................ Address .................... . .......... Phone NO ..................... Name of Contractor.....~.J~....~ ............ Address i~i~;.:.~i~ i'. ........ 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. /91 STATE Of NEW~YOR. R.R.R.~)c ) S S ................................ ./....'.~..../....~....~ .................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) _ above named. He is the ............................................................................................................................................................. Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly autho~zed to )erform or have performed the said work and to make and file this application; that all statements contai~ application are true to the best of his ~owledge and belief; and that the work will be performed in~e~~th in the application filed therewith. Sworn to before me this ........................ of: ....... ........... ef Nota~ Public, :~F~....~..ZZ~;~