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Home My WebLink About875-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at -~[/~.....0~l~.t~...P~d....JT~ne ............... Street Map No. "::~_'~t .......... Block No .....~'t"~ .......... Lot No. "~q'~'""~¥'""~'i'~'~ ..................... conforms substantially to the Apphcotion for Bu,ldmg Permit heretofore filed in this office dated ....................... ~t, el~....-~,~, 19..j~., pursuant to which Building Permit No ....... ~..~. ........ dated ........................... 0~(~]0e~.-.-.'~ 19..~i'9., was ~ssued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is ................ ........................... ~. ~ a.~e.. ~n~.. ~'~.~Ly... ~.~.r~ ..................................................................... This certificate ~s issued to ....]i~¢...~t~l.~ii~..]~,~l~(fte~ ............... ~-~. .................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector \ FOl~[ NO. 2 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.° 875 Z Date .................. October., .34~ ................ 19.~.,. Permission is hereby granted to: ~ llor~lv~...&~/~....~e~.~..Bender.. ........................ .... · (~j~%e~ -T'mzd~ -T~ .......................................... ........ ~i~ut~....IT.~f.. ............................................ to .~_,~..an-.a6d~,%.~on.. ~n..~tn.. e~.~u~.. ~I.% ~_~ ....................................................................... at premises located at -lJ'~ .Oy~%e~,'...l~O~.~..~ .................................................................................... .............. ~ ........................... Oa'&.e~t.~, ..~,,~,, · ........................................................................................ .......................... · ~te~/,',"--~l~ ............... 19e~...., and approved by the pursuant to application dated . Budding Inspector Fee $.~.m ............... FOE1V~ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×omined ....... ...... ,97. Approved ~t ~ 0~ ~ ~' ............................... '9.. ii.Permit No ,.,~..~ ......................... ///' / APPLICATION FOR BUILDING PERMIT Dote ..................... ...... ,9 .... INSTRUCTIONS o. This apphcahon must be completely filled m by typewriter or mmk and submitted in duplicate to the BuIIdinL Inspe~ctor. _ b. Plot pJon showing locution of lot ond of buildings on premises, relohonship to odjommg premmes or public street_- or oreos, and giwng o detoHed description of loyout of property must be drawn on the dlogrom which ~s port of this locution c. The work covered by this opi~licotibn moy not be commenced before issuonce of Building Permit d. Upon opproval of this opphcation, the Budding Inspector wdl issue a Building Permit to the opphcant Suck permit sholl be kept on the ~rem~ses ovoHoble for inspection throughout the progress of the work e No building sholl be occupmd or used m whole or m port for uny purpose whatever until o CertH:~cote of Occuponc¥ sholl have been grunted by the Budding Inspector APPLICATION IS HEREBY MADE to the Building Deportment for the ~ssuance of o Budding Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordnances o~ Regulations, for the construction of buHdmgs, addlhons or alterahons, or for removal or demohtion, as herein descnbed. The applicant agrees to comply wtth oil apphcable laws, ordinances and regulations (Signature ~/f applicant, or name, if o corporation) Or ~e~4~ / · ,1~ o~v..y o rk~ .................................................. (Address o~ apphcant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrican, plumber or builder ~ C c~r~o~or Nome of owner of premises .... ..~.i..1.d...~.....~,a ..~...e..~.d..~.?. ........ If apphcant is o corporate, s~gnature of duly authorized officer (Nome and title of corporate officer) 1. Locahon of land on which proposed work will be done Map No ........................... Block .............................. Street and Number ...... .O~s.te~'...~...o..n..d ..~ft~.~....O?.~.9..~ ........................................................................ 2 State exishng use and occupancy of premieses and ~ntended use and occupancy of proposed construction' a. Existing use and occupancy ................... .D.?.?..]....]:~..~..~ ........................................................................ b Intended use and occupancy ......... D.w..~l...1..i..n.g .......................................................................... 3 Nature of work (check which apphcable) New Building .............. Addihon ..... ~ ........ Alteration .................. Repmr ................... Removal ................ Demohtion ................. Other Work (Describe) .............. 4 Estimated Cost ...2..160. ~. ....................................... Fee ................. ~..: 9.0. ............................................... (to be pa~d on fihng th~s apphcation) FEES 5. If dwelling, number of dwelhng units ......... ..]~1,..~ ........... Number of dwelhng units on each floor .. If garage, number of cars ................ ~l.~. ...................................................................................... 6 If business, commencal or mixed occupancy, specify nature and extent of each type of use .......................... 7 Dimensions of ex~stmg structures, if any Front ...................... Rear .............. Depth .... Height ............................ Number of Stories ....................................................................................................... D~mens~ons of same structure w~th alterahons or additions Front ................ Rear ..................... Depth ............................ Height ......................... Number of Stones ....................... 8 Dimensions of ent,re new construction Front ..... ~/~... ........ Rear /...'~.. · ......... Depth ..../..~ ....... Height ............................ Number of Stories . ..~.. 9 Size of lot Front .... ~..,~. ........ Rear ..... .~'..~ ............ Depth ... 3-?.2~,J4.9 ..... ]0 Zone or use d~strict m which premises ore s~tuated ................................................................................ 11. 12. Does proposed construction wolate any zoning law, ordinance or regulahon~ ....... ~..q ................................... Name of Owner of premises..~'~ ]d~. l~,...~o~d.~..~kc~dOr~ss ~.~.LI:.]'...'..]:'...A...v..e.'..,..~..~..~.....Phone NO ..~...e...~.-.6..Lj Name of Architect ..................................................... Address .......................................... Phone NO ................. Nome of Contractor ....... ~.9~r...]~p,~.k.]J, gD, ...............Address ..0~$.~.~.1~.~] ,.~., ................. Phone NO ................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back d~mensions fro~ property lines. Gwe street and block numbers or description according to deed, and show street names and ind~coi whether interior or corner lot, STATE OF NE~ YORK, ) COUNTY OF~ ......... ) 5 5. Ton~ ............................. ~~..~9~k%DB ......... beln~ duly s~om, deposes snd (N~me of individual s~nin~ above named. He is the ....................... .a...o..~..~.z,..~.g..~..o..z'.. ...................................................................................................... (Contractor, agent, corporate officer, etc ) of said owner or owners, and ~s duly authorized to perform or have performed the smd work and to make and fil this applicat,on, that all statements contained m this application are true to the best of his knowledge and betieJ and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........... ; .......... day of .............................. 1 Public, ...?./~... 0,/~/~' ~~ County Notary ................. .-t-..~. ........................... / (Singature of apghcant)