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Home My WebLink About898-zFOR~ ~'0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ll/'~, ~t~i. l~,Ot~, .B~lltltO)~ Street Map No ........~.~..~. . Block No... ~*.* ....... Lot No ..... *.*.~ ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ N._.o~.....~. er .~2 , 19 59 pursuant to which Building Permit No ..... ~...69~.... %ted ............. ~lOV~e~. L~ .. , 19 $9, was issued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is ....................................... ..r ......................... This certihcale is issued to Ho B~...F.a..tIc.on.~ owrre$.' ................................................ (owner, lessee or tenant) of the aforesaid building. Building Inspector \ FORM NO. ~ 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.o 898 z Date .......................... Permission is hereby granted to: ..... ..~..~ ......................................................... at premises located at ..~'~..~,.....~..~..~,...~..,~..,,......~.~.~ .,~.:..~.:. ........................... pursuant to application dated ~ ]2 19~1) .... : ................................................................. , and approved by the Building Inspector Fee $..~.,.(~0. .............. Building Inspector FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ..... ,,. erm,t No ....... ....... Disapproved a/c ........... ~ ~L%'~ ...... ~~ .............. ........... .... (Building Inspector) ~ ~ Application No.....~..?.. ................. APPLICATION FOR BUILDING PERMIT Dote .................. ,. ........... , 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 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 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. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu der. Name of owner of prem.ses' ........ ~. '..~......~' · ......... '~..~.~~' .................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) , ~ 1. Location of land on which proposed work w~ll be done. Map No ............................................. Lot No ..................... Street and Number .....~..Z ~ ~~ ~0 ~ ~ ?~ ~ /q,/,/~-, Municipality 2. State existing use and occupancy of p~nded use and occupancy of proposed construction: a. Existing use and occupancy ...................................... ~ ~ ....... /-'~'""'"'~7~'~ .................................................... b. Intended use and occupancy .................................................. /.. ............................................................................ 3. Nature of work (check which applicable): New Building .................... Addition.....~ .......... Alteration .................... Repair .................. .~.Removal .................... Demolition ............. ~,u~- Other Work (Describe) .................... 4. Est mated Cost .......~... ................................................. Fee .......................................................................................... (to be paid on filing this application) §. If dwelling, number of dwelling units ........ ~ ...... Number of dwelling units on each floor .................................. If garage, number of cars .................................... J.' ....................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, Jf 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 constructJ~: Front ........ ~ ............... Rear ....... ~ ................ Depth ~ Height ............................ Number of Stories ................................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former ~qer ..................................................... 11. Zone or use district in which premises are situated ~ ' ~' 12. Does pr~osed construction violate any zonlng law, ordinance or regulation? ........................................................ 13. Name of Owner'of premises ........................................ Address .......................................... Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name o~ Contractor .................................................... Address .......................................... Phone NO ..................... PLOT DIAG~ L~ate clearly and distinctly ah buildings, whether existing or:pr~osed, and indicate all set-beck dimensions from pr~erty li~s. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF N~O. OJl~Co)r ) S S COUNTY OF _..~...~..~,..) ' ' ~-, .......... ' .............. .."..1~..'.....~...~..~..~ duly sworn, deposes and says thor he is the opplicont (Name of individual signing applicotion) above named. He is 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 the manner set forth in the application filed therewith. JUDITH T. BOI(EN Sworn to before me this ~to~rv Public, State of New Yerk ~"/~ ~2.~344963, Suffolk Cou~:y ............................. ........ ............................... /:,'. Notary Pubiici~r,.~,,4~ ..~.,..~',~~... Co--,~t¥ (Signature of applicont,