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Home My WebLink About353-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...Z... ~.6 ..... Dote ..................... ~'..1~.~.. 2.~. ............. 19~.~... THIS CERTIFIES that the building located at .,~J/.~,..J~Jt.~l..~O~9,d ................................ Street Map No .... ~JLXX ................. Block No ...... conforms substantially to the Apphcation for Building J)erm~t heretofore filed m this office dated ..................... ~'II~e...-'t.~ ...... 19..~'~ , pursuant to which Budding Permit No ........ ~...,,~.~ ....... , dated ........................... Jllrle ..'ib~ ........... 19....~J~, was issued, and conforms to oil of the requirements of the apphcable prowsions of the law The occupancy for which th~s certificate is ~ssued is ............ ....................................... ~.i~t~'~E I'~IF~LL~[ ~ .................................................................... This certificate is issued to ..~,,...¥/s.t'd. .......... ~..O~'lel'.) ................................................................ (owner, lessee or tenant) of the cforesmd building Buddmg Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTARENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER/v~IT ~ (THIS PERMIT MUST BE KEPT ON THE PREMISES UN FULL COMPLETION OF THE WORK AUTHORIZED) /~ ~ \ '.,tx, Permission is hereby granted to' I \ ~ T~ ~r~mt Cha~ A/C ~. ~ard , ~,. ................................................................... L.~v ~.. ~ ~ Green~rt ~ ~ ....................................................................... .':,. ..... ~t ' to ................ ' .......................................................................................... ~..~ ..... ~..t ........ : ........................ ' c~ prem~s&s ~cted ~t ........................................... z,- .... ~ .............. ~ ................... .......................................................................................................... t- ............. ............... ................ .: ............. : .................................................................................... /.. ~ , ,~ t Pursuant to apphc~t,on dated ~e 1~ .~ ~a ~ ......................................................... 19..j?..., and approved by t~e BuiJd,ng Inspector ~] /J' '5 ~:'- Fee $...",~.~ ........... / "5~ ', FORM NO. I TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .................. 19. Approved ........................................ 19 ........ Permit No ............................... Disopproved o/c .............. ~ ........ :,~ ........... .-~ .................. ;;,,~ .......... .n~ .......... --'~ .................. ....... (Building Inspector) ~ Application No ...... ,?....Eiii ,~ ........... 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 dlagrom 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 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 part for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MAD£ 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. (Signature of applicant, or nc~e, if a corporation) Greenport, N.Y. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Geco A. Wa~ci Nome 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: ............................................ Lot No: .................... Street and Number .....~...&...~...?....°~.d:s.....~..?..t'...~?..a.~..?.*.~.? .......................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and OCcupancy of proposed construction: Residential a. Existing use and occupancy ..................................................................................................................................... b. Intended use and OCcupancy .............. ~..&D...®. .......................................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal . ................... Demolition .................... Other 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 ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 7" 8. Dimensions of entire new construction: Front ............... . ............ ~ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ of Purchase ......... ~'..~.~....~..[...~...7.. ............ :.Name of Former Owner ........................................................ Date 11. Zone or use d~stnct .....n wH'ich premises are s~tuated ........... ..~.....~ ................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~.O. ...................................... ~remises A. Waz'd A'dres ~st ~Ja~ion 13. Name of Owner of ~, ........................................ a s ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO Name of Contractor....~.*...~.~..i~..~ ........... Address Oree~po:~"t,, ,.~'. Phone '~J~ ......... 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 NEJf~O[j~:u_~/ ) S S ...................... ~.(' .'.~'--.~..'~......~.;~i~.....:....being duly sworn, deposes and says that he is the applicant (Name of individual signing applicahon) above named. He ~s 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 this application are true to the best of his knowledge and belief; and that the work will be performed in th~ rnal~sr set forth in the application filed therewith. Sworn to before me this fi ........ · ~...~......'.~..... day of ..... -- ~,,~.~..- .~~:,~,~...,.~8.-[~,¥otlt (Signature Of applicant)