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Home My WebLink About653-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the buildin located at .~../.~. ~,D, ~t!~.~ (~,~?t~tt'~10~e) ¢treot ,,~ g *** "~L;"'~'~;'"~'6~i~6~.~ ......................... ~ Map No ......................... Block No ......................... Lot No. ]1,~,~.,~...~.~.}...~..~ ..................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................... ~.~.iZ..~.. ............ 19..~',~., pursuant to which Building Permit No...~.....~.~.~ ............... dated ..................... ..~.]~..~.?. ............. , 19..~.?.., 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.~t.~'.~.z..~.~.>.,'...~.~':~:~?.,. .................................... This certificate is issued to ..~.~...e:~,..~..9..~..?.~.~..O.~!~.?.~. ...................................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector HOWARD M. FOI~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.° 653 Z Dote ...................... ~,]~1~1~.... ~I~. ................ 19~.~. .... Permission is hereby granted to: D~ L~. ~r~. &. ~*~m... ~/~... ~.~k....I}el~k .......................... .... 21....B~n..~:~ .................................................... ............ .RLwr, head~....~oZo .................................... to..But ~.. new.. one.. £a~.ty.. dwe,~.t~ ............................................................................................... at premises located at ..~.~....~.~.,,~.~t....[..~;r.~.~.~,~.~.~.).~..t...?.~. ...... ~..(.~.7/.../.~.b../..?/. ..... ................................................... (Ir.~a~.~J;~ ....~b.~., .............................................................................. pursuant to application dated ........................ AiI~'~].....~. ..................... 19.~.~..., and approved by the Building Inspector Fee $..1~_?...0~.. .............. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ........... f'"'."fl ......... ;z~ ......... ~ ........ fl .......... '"~'"'" ................. ..................................... L .............. .......... ....... .............................. (Building Inspector) Application No. APPLICATION FOR BUILDING PERMIT Oote ....................... (/. ...... '. ........................... i r ............ INSTRUCTIONS o. This application must be completely ill[ed in by typewriter or in ink and submitted in duplicate to the f~uilding 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 p art 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 issuanc,e 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 o Iterations, or for removal or demolition, os herein described. Theapplicont°greest°c°mplywithallap~licablelaws'°rdinances~f~regulr~i~/~s' iff () ....... .............. (Signature of applicant, or name, if a corporation,~ (Address of applicafft) crate whether aoplicont is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .~ Ii~' ,',~,. .>. . Name of owner of premises...Z.../.::./'..~..!~'I.....K. ..........~:6,~../..¢,~,__ ................................................................................... oppl cT , o. po ed . ?ure of off ce . ......... ~ ~ ~~~orato officer) ~9 ~ ~' ~ o ~ .............. ~ ..... 1. kocotion of Iond on which proposed work will be done. M~p ~o: .~.~{S.~'!~.?r~;..~.:~..:?:,,.~,:.¢~.~L<. k t o /~,/F~/~ Str~t and Number Mun~c~pahty ~ ' 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existi~ ~s~ a~d occupancy ............... ~ ................... ; .............................................................................................. 3. Nature of work (check which applicable): New Building ......... ~ddition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.;.~..]..~..~..O..~.:~. ..................................... Fee ../...!~..:;~: ....................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... ~.:~.~,~,,..~....Number of dwelling units on each floor ............................ If garage, number of cars .......... (~9;...'~.~: ................................................... 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 ......... ..~.~: ............. Rear ........... f.~.~ ........... Depth=~ll~..~.~.~'~ Height ............................ Number of Stories ...~19:.~.~...~. ....... 9. Size of lot: Front ........./.~....G,.., ....... Rear ........ :~...~.~. ........ Depth ....z..&,~ ............... 10. Date of Purchase /..~ ~,'..x..~..~..C2 .............. Name of Former Owner ............ ~.'~..:...~.~.~,~,,.,. .............. 1]. Zone or use district in which premises are s~tuated ................................. ~.~,~.~.,t .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... .A/..,~ ................................. 13. Name of Owner of prem~ses.f..b~,~...~')_,,.~'~,,.~,~*,.~ ........ 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, and show street names and indicate whether interior or corner lot. l STATE OF NF-W YORJK, ) S S COUNTY O F ~,¢:~..6:.~. ......... ) ' ~[~ ....................... be ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) abow~ named. He is the .................................. ..~:m,,.~,4¢~.~.-~.. ...................................................................................... (Contractor, agent, corborate 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 t_q. the best of his knowledge and belief; and that the work will be performed in the manner set forth in t~lzi~pl~l.ic~J~ f~d therewith. Sworr to before me this ~0t~v ~'~l~l~,~s~s~uO'01~'~o"~t,-~/!