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Home My WebLink About389-zFOI~I~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .~..~I,~. .......... Date .............. All~tSt .~(~ ........ 19 .~8.. THIS CERTIFIES that the budding located at ~...~l~.~..~l~.... ~.~ .................... Street Map No ..... ~ .............. Block No ....... conforms substantially to the Application for Build~ng Permit heretofore filed in this office dated .................. ~!.~]..~...,,1,;~ ............. 19..~.t~., pursuant to which Buddmg Permit No ...~..,,~.~ ............. , dated ............. ~!~'!~.....]J~ ....... 19..~'~ , was issued, and conforms to all of the requirements of the applicable prowsions of the law The occupancy for which this certificate is issued ~s ............ ......................... ,PRe'I/ATE .D~, h'~LZ.N~ ......................................................................... This cerhficate is issued to .~.... T,~ ........... ~...O~P~O~'.~ .................................................. (owner, lessee or tenant) of the aforesaid budding ft Buildmg Inspector ~o~ ~o. ~ TOWN OF $OUTHOLD 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) N.° 389 z Date ............. ~'-,~.....'1~ ............. 1~ .... Permission ~s hereby granted ~fl~omas Werntk~w~.[...- .A/~.... ~o.l~...Luke ............... ............. ~x--~.~ ...................................... ............ ~t~ttu~k~ .... ~.'~'-' ...................... to ............... ~td-"~"~tditTon-'~n '~"wxim~;~' ~'~'~fn~ ........................................ at premises located at ..... :[~t~'~l~r" '"~.~/'1~ ......................................................................................... ............................................................. }~a~'~, .... ?~;'~t; .......................................................... pursuant to applicahon dated ........................ ~1~I[.y.. .~ .............. 19~..., and approved by the Budd,ng Inspector Fee $"5~0 ............. ~ ' - Building Inspector FO~tM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... Approved......~. .............. ' .................. 19 ........ Perm t No ............................... Application No ........).. · .~...2. ............. Disapproved o/c .......... ~. ............. ~ ..................................................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ....... ,'~.y ......... t.~. ..................... 19. ,~,..,~,... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and suJ~mitted 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 drown 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 <3 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 o 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 ............ ~~ ...... J--,~. .................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which prop,osed work will be done. Mai) No: ............... .~ ........................... Lot No: .................... Street and Number ............~'~ ...... C/~ ..................~....~~ .................................................. ~1~ Municipality 2. State existing use and occupancy of premises and intended u~se and occupancy of proposed construction: a. Existing use and occupancy ........... .~ ~~ ................ ~ ............................................................ b. Intended use and occupancy ............ ~ ....... .~~). .......................................................... 3. Nature of work (check which applicable): New Building .................... Addition ..~ ....... Alteration .................... Repair .................... ~moval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... ~....~..).--...0...:....O....O. .......................... 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 ....... ./...~'..i/. ............. 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 .........../. ............... 9. Size of lot: Front ........ .~...~..~....i. ........ Rear ....... ~...~.~..~. ......... Depth .... .~.....~...~. .............. 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 1]. 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 premises...~/~'Q.~..~.....~.~/~./i~..Address ....... ~./~...~../..~..~'. ......... Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor...~,~ .~.//~ ...... ~...~./~,,/VJ..~.~..~.~.Address ...... ~.~...~..L.~...q..~,~ ......... Phone NO. ~:~9.~.../-~..~?.O 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, ar!d show street names and indicate whether interior or corner lot. · 20' d' STATE OF NEW Y~RIg~ ~/ ) SS ' ' COUNTY OF ..,..~.(....) ' ;r/'"77'-'-7';" / Z" ................ ./..~..9~f~r~.........~/~....¢~~: ....................... being duly sworn, deposes and says that he is the applicant [Name of individual,/~,__ .~'~. ~signing app~li~ation,) above named. He'Is the ........../..z-....~cc-cz-II~r......~,,,~,.&:..~.,.t~a~,~,~ }-'~" ..................................................................................... '"~'~ ~c~. F~7'f~9~t, corporate officer, etc.) of said owner or owners, and is duly authorize~ ~j;~l~br~.~c~_ I~'~ret~erformed the said work and to make and f e this application; that all statements contained in'fl~l~lf)l~/~[l~ a're true to the best of. his kngwledge and belief; and that the work will be performed in the manner set forth in'"~rlh~l~licat~n filed t, be,r~ith.~ Sworn to before me this ,~ ~ "-'1/'!':'! /,//~ ,/ ~", ./..1~..'. ...... day of ........ .~./.....~:....:..7. ............... 19 ............ (Signatu~of applicant) Notary Public, ~.~.~Z.......~C'ounty