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Home My WebLink About917-zFORJVI NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~,, 1262 Date ~&n~ry 23 19 62 THIS CERTIFIES that the building located at Map No.** ................. Block No...~**, .......... Lot No ................. ~*,gt ........................................... conforms substantially to the Application for Budding Permit heretofore filed in this office dated ............. ~L.-~r~a~:r...2B ......................... , 19..5.~. pursuant to which Building Permit No. Z...9,~.~ .... dated "'~~""2~ ..................... ' 19....~.9 was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .......... .......... ~...0~ · · ~'Ag;ZZ.'Z.. ~~ ............................................................................... Th,s cert,f,cate ,s issued to ............ .~.~.];~. ~.~._~T.e../~'~.~T¢'~....~...t'~Q..~.~...~.~...~..c~....~.~L..~.e~'/~ (owner, lessee or tenant) oF the aforesaid budding ............... °~°1~1° i" i'd'i"n'g' ';A;pect!r " . FORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Office of the Building Inspector Town Hall Southold, N.Y. Certificate Of Occupancy No..gq a.1.9~ ........ Date ..... Scp. h~mbo.~.. ~6 .............. 19,.~. THIS CERTIFIES that the building ................................................ Location of Property p...v.Q. North Ro~fl ~ Bayvtew Southold ~louse No. Street Hamlet County Tax Map No. 1000 Section . 0.7.9. ...... Block .. 02 ........... lot ..... qQ~ ......... Subdivision ...... X ........................ Filed Map No.. ~ ...... IL,et No..~. ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated .... 4~tn.e.. 3 5 ......... 19q.2. pursuant to which Building Permit No...1.~.~6..5..g. ........... dated ..... ~T~tu.e.. ~ O ............... 19. ~ .2, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ......... ...... .a..d..e.c.r..a..~.d.~.t. t O.n..t. 9..~.n..e.x. ~.s.t.~ .nC..qV .e.:L.Z.~.n..~: .......................... The certificate is issued to ....... ~.he~ ~, ,J.,. &, ~l(~na. ~,, ~.c.~t r'.~[a~. .................. (owner, ~ ,~c~,errtj of the aforesaid building. Suffolk County Department of Health Approval ...... z~[~ ................................. UNDERWRITERS CERTIFICATE NO .............. rzZ~ ................................. Building Inspector Rev, 1/81 ]FOlZlVi :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.° 917 Z Date ................ ~'.~I.~T...,, ~. ................. 19~ ..... Permission is hereby granted to' ~..~....~ .............................................. ....... 4.t-,I~. ~. ~t, ......................................... ..... ~~..~,..~.-.T., ......................................... to ..... ~. ~r,~.~g.~.c~e.~u~...~..~.~.~...o.~..~..~...~..~..~J~ ............................ at premises, located at ..~..~.9.~.1~1R.~..~1~ ............................................................................ pursuant to applicahon dated .................... ~...~!~.~1~.......,~.. .................... 19~.,..., and approved by the Buddmg Inspector Fe~ $~.~....l~ta. Building Inspector FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ........ Approved t' 19 ........ Permit No. ~'- Disapproved a/c ............... ................ ............................ (Building APPLICATION FOR BUILDING PERMIT Application No .......?...(..~.. .............. 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 port 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. ................... (Signature ~pplicaJ~t, or name, if a Fojrporation) State whether applicant is owner lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. [J ~ (Name and tTtle of corporate officer) 1. Location of land on which~,.~cn p~.~cn ~ ~ ~pro ese work will be done..Map No: ............................................ ~,ot No: .................... Street and Number /~-~../.~....~..:~:~~.~..~; ............................. a. Existing use and occupancy ...~~_~.i.....~'/~'~9~J~-~'~ ............................................ b. Intended use and occupancy..../~(....C~~....~.....~.C.~. .................................................. 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... - ............................. Fee ..................................... ~ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... Number of dwe ng un ts on each floor.:..'~. .................. If garage, number of cars.....~..~ 6. If business, commercial or mixe~occupancy, specify nature and extent of each type of use....~ ................ 7. Dimensions of existing structures, if any: Front..~.. ............... Rear .....~...~. ........... Depth ......~....~.. ................... Heigh ~.. ...... 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 ............................ Rear ............................ Depth .....'~. ....... 10. Date of Purchase~.~...~.~../.~..~............... 11. Zone or use district in which premises are situated .................................................... 12. Does proposed construction~ · .~,~----,r ~, ,vic~ate amy zonir~ 10W, ordinance or regulation?__ ~ , -","'"v'""-~-."..;.'Z~" ............................................. ,ome o, Owner of 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, and show street names and indicate whether interior or corner lot. STATE OF NEWcYOR~ ~ ) S S COUNTY OF ..,~r:f~'~/.~:) ' ' ................ i~'~'~'~"l~F'~";'~"~-" '~;~:~;'~'~''~in,o, .nav,aua, ~ ~ -- duly sworn, deposes and says that he ', the applicant above named. He is the ...................~ ...................................................................................................... (Contractor, agent, corporate officer, etc.) 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 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 m~.,,. ~ ~ ~ r e ,~th in the application filed therewith. Sworn to before me this ;';;;;;;";u;l'ic,'~~'"z'"';~~;.. '~ (Signature of applic,nt, ¢