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Home My WebLink About675-zFO~M ~0.4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~ N. Y. CERTIFICATE OF OCCUPANCY No. Z 2.cJ2 at ~ 13 1~?. ..... THIS CERTIFIES that the building located at...~./..~...~.~Y..~.~....~...~.~..~..e...~,e.~.?..~ ............. Stree~t Map No~8.~.~.~.8~l~q~.. Block No ......................... Lot No ..................... ..0..~..~.9..h..,o.~L,.~.*...~.:..~.:. ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... ~..,..~ ............. , 19.,~..., pursuant to which Building Permit No....~...~. ............... dated ...................... ~.~....~ .................. , 19...~..., was issued, and conforms to ail of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. ................ ?.r~ .~.~.. m?.~.. ~'~.$.~...~. ~.~.~.~t;~ ......................................................................................... This certificate is issued to .................................................................................................................... (owner, lessee or tenant) of the aforesaid building. FOt~M 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? 675, z Date May 13 59 Permission is hereby granted to: ~:t~gene ..Jiort, o~... A/a....~e~.. ~mrr~.¢~ .................... ................ }few S~f.el.k. ...................... at premises located at ...l//5.~ay..Ave..&..pine..~.e.e..ltcl ..................................................................... ........................................................... ~.~b~...e. ................................................................................... pursuant to application dated ............................. ~.IL...13 ...... .~-.?.~.~. ...... 19 ........ , and approved by the 13uilding Inspector Fee $.,.~.~.. ............... Bu Iding Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. · Examined 5 . Approved ........................................ 19.....~.Perm~t No .............................. Disapproved a/c ..................................................... (Building Inspector) 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 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 al~plicant. Such permit shah 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc.e of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ............. ............... (Signatu~'e of applicant, or nome, if a corporation) ............ (Address of applicant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electric/an, plumber or builder. Name of owner of premises ......... .~ .......... .~..~,.^ ......... (. ......... ..~../ .......... .x¢,~ ....................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done, Mop No: ............................................ L~0t No: .................... Street and Number ........ :',,~, · ....... .'5:.~. ...... ...~....~.. ......... ~'.~:\.~. .... ~ /Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Ex/sting use end occuponc~ ....................................................................................................... b. Intended use and ~u~nc~, I r. 4. 5. 6. 10. 11. 12. 13. Nature of work (check which applicable): New Building .................... Addition .................... Alteration '"I ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... Estimated Cost ~/.~ ~ Fee (to be paid on filing this application) If dwelling, number of dwelling units ......... ~ .......... Number of dwelling units on eoch floor ........... 1 ................ if garage, number of ' If business, commercial ar mixed occupancy, specify nature and extent of each type of use ............. ~ .............. 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 ................................ Dimensions of entire new construction: Front ....... ~.~..A. ............. Rear ........ ~.r...~../ ........ Depth ....~.....; ................ Height ............................ Number of Stories ....... ~ .... Size of lot: Front ............................ Rear ............................ Depth ............................ Date of Purchase ........................................................ Name of Former Owner .... < ................................................. Zono or use district in which premises ore situoted ................................. : ................................. Does proposed construcHon v~olote ony xon[n~ Iow, ord[nonce or re~ulotion? ................................................... N~me of Architect ................... .} ................................... Address ............................................ Phone ~0 ..................... ~me o{ Controdor...~..%.. 2~.,.. ................ Address ............................................ Phone ~0. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimen~ property lines. Give street and block numbers or description according to deed, and show street names ant whether interior or corner lot, ions from indicate STATE OF NEW ~01~1~, ~/Z ! S S COUNTY OF ..",~.~-~f.-~f-~.,,J ' · ................ be,ng ' (Name of nd~ual signing application) , 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 al statements contained in this application are true to the best of his knowledge an J belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before~e this ~ ~0~ ~o~ ,, ~ ~' o~" ~o~~ J ~ ~f ~ 19~ ~c Sts~ok~ ~>~gnature of app cant) ........................ a~ ~.~ ................... ~.~ .....~..~..~ ~ ~, ~s~ ~ . / .~