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Home My WebLink About897-zNO. 4 TOWN OF SOUTHOI. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY [Date ......................... Jtue, e...~ ................. , 196~).-. No .,?,...270 .......... THIS CERTIFIES that the build,ng located at Map No ~ ................, Block No ...... ~ ............Lot No. :x::X...,.:l~ct~,~jz~,l~o1~). ..... ~.~.~; .................. conforms substantially to the Application for Building Permit ~h~retofore filed in this office dated ............................. N~%....~O ......... , 19.~.., pursuant to which Building Perrmt No. 'a~"89~/ ............. dated ...................... ~e~b~-.-.-][O.. 19.~..., was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which th!s certificate ~s issued is ................ ................ l~.~.v~te..~n~..~. ~t.t.;r...~4,~e~.1~,~ .................... i ............................................................ This certificate is issu~ed to ..~r..~,~*~cO~ .............. (. .~1") .................................................... ~owne~ lessee or tenant) of the aforesaid building. ........ ................... / ~u~[aing inspector I FO]~M 1~'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? 897 Z Dote .............. .l~v~l:~.....].~ ............... 19~:-).... Permission is hereby gronted to' l~a.t ~,~r..t~ ~.~,.tt~, ...,~/~... J~,s.v~.....~...~r...~..~ ............... ~- t~ ~' ................................. .......... jl~t, tJ. r,,~t~.~ ~ ...... to ;11~1,~. ~..&¢.~ ~tx;t.011..~.~...&~ ..f~. ~..s..t:~.~g.. ~,~ ....................................................................... ot premises Icx:~ted at ...~a+~]~-'t~l~..t~.l~.~L.~.~.~ ..................................................................... ............................................... ~.~.~,t~..~.~.~ .......................................................................................... pursuant to cpplicat~on doted ....................... If~ea-....,~ ............... 19,q.~...., c~d approved by the Building Inspector Fee Building Inspector FORM TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~..~...~....., 19.....~.. Approved ..................... .~...~. .......... , 19...~...Permit No. ~,~2 ~ 7 Disapproved a/c ......... t~'~ .......... Application No .......~r~..~....?. ............ 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 prol~.rty 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 avc~ilable 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 a 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 alterations, 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 a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whic.h propose.~work w'll be do e. Mop No: ............................................ Lo No: .................... Street and Number~..~./....'~.... ...... ~.~.......~.....(~...../..~.........~...~..~........~...~ ....... ...~.....~: Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing u~e and occupancy ............ ~ ................................................................................... b. Intended use and occupancy ..........................~.! ............... ....~./~......~..~..: ...................................................... 3. Nature of work (check which ap~olicable): New Building .................... Addition ....... ..~... ........ Alteration .................... Repair .......... Removo .... Demolition ' Other Work (Describe) 4. Estimated Cost .....~.:t..~....~'...O..~ Fee - ' ......... ................... 5. If dwelling, number of dwelling units ....... ~ ...... Number of dwelling units on each floor .................................. If garage, number of cars ...................................... :...i .......... ~ ....................................................................................... 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 ................................ 8. Dimensions of entire new construction: Front ...... L...~..,.~.....~7. ...... Rear ...... ...'~......~....[. ....... Depth ....L'....~..?....¥. .......... Height ............................ Number of Stories .......... ~ ....... 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name~/~fdCol~.er' Owner ........................................................ 11. Zone or use district in which premises are s tuated ~ 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 property lines. Give street and block numbers or description according to deed, an show street names and indicate whether interior or/.:~rner lot.~J _ ~f I STATE OF NEW~ ) S S ..... ~ .......... '~-"~~~~ ~~' ...... being dulysworn, deposesandsasthatheistheo Ii ant above named. He is the ................... ~~&~ co pgmte e;g, ....................... of said owner or owners and is duly authorized to perform or have ~rformed the said work and to make and file this application; that al( statemen~ contained in this application are tree to the best of h s knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. JUDah T, BOKEN Sworn to before me this ~ota~ public, State of New Yort I~ ~ ~um~c, ~.~;..~. ~ ~ature of applicant)