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Home My WebLink About753-zF~R~ N~. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z 66'~ Date June 15 19 60 THIS CERTIFIES that the building located at ..~.&..~b~.~..~ll;.l~,,...~.O~t,.h~,]J~ .......... Street Map No ............. ~t, ....... Block No ....... ~t~ .......... Lot No ........................... ~t~ ................................ conforms substontiolly to the Applicotion for Building Permit heretofore filed in this office doted ........................... .~...~.~....~.. .............. , 19.5..~...., pursuant to which Building Permit No ......... .~.....7...~..~ ...... dated ........................... ...J~....]..~.....6. ............ 19...5..~., woe issued, and conforms to oil of the requirements of the opplicoble provisions of the Iow. The occuponcy for which this certificote is issued is ................ ']'his certificote is issued ta ~o~t:he~d_l~e~thc~LaY...¢hu,r~h.,...ceme3c. ....................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FOI~M NO. 2 TOWN OF $OUTHOLD 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 753' Z Permission is hereby granted to: at premises located at ~.~...;Jli~n..J/~d ................................................................................................. ................................................ ~.?.t. ~ .,.....~..~.,. .................................................................................. pursuant to application doted .............................. ~'1~......~ .................. 19~...., end approved by the Building Inspector Fee $... ;~'~. ,('.~11 ........ Building Inspector FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined ........... (~/x~.~...~.... 19...6...~' Application No ...... ""~ '"'"'"~ ......... Approved ............. (-"/(~')/J~..Z~....19~..~....Permit No ..... ~.~... ..... Disapproved a/c .......................................... :~ ..... :":'~'"'Z~L'~' ...................... ( 'd' g specror) ~ (./ 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 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 o 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. Locat on of land on wh ch proposed work w II be done. MaD No: ~ ........................ Lot No' . .... Street and Number .'~.Z...~.......~.~...%..~'.[.~.......~......~......~..;...~... ............... ~~/....~.....i ...... Municipality 2. State existing use and occupancy of premis~ and i,,ntended use and,pcc, upancy of proposed construction: a. Ex st ng use a d occupancy .................~...:.... ............................................... .~ ........................................... b. Intended use and occupancy ................................................ C~ ............. .%.: ......................... 3. Nature of work (check which applicable): New Building .................... Addition ......... ~ ........ Alteration .................... Repair ........... ]~ ...... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....~..~...°'.~....~......'~.. ...................................... 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 ......................................................................................................................................... ~.~-...__ 6. If business, commercial or mixed occupant=y, specify nature and extent of each type of use...~r..,~...,, ........ 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... ~..~..T..' ....... Rear .............. ~...~..~. ..... Depth ...../..~.i ................ Height ............................ Number of Stories ..... ~ ...... 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ................................................................................................ 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, and show street names and indicate whether interior or corner lot. STATE OF NEW,r-YOI~ 0// ) S S COUNTY OF .....~ff'...:~dl. ~¢~..) ' __ ~..~.... ...... ~..:~ .......... being duly sworn, deposes and says that he is the applicant (Name of individual sigh'lng applica~io]) ' (~ .............................ithei'"'i'r~ .................... ~,~,~, ~_,~_ __ above named. He's ................................... '('~'~t]~:t~.~"c~'~;"~.'l~'r'~'t'~"~"~ii ........................................ of said owner or owners, and is duly authorized to perform or have performed t~ne said work and to make and file this application; that all statements contained in this application are true tox,t~,d best of his knowledg~ and that the work will be performed in the manner set forth in the applica.t~/,fil~d th~-w~t1~ -'~,/.~//' Sworn to before me this ~ ~ - '¢- ~//~ Z~:_./~-~'/~-~t~ , ................... .(,R.. day of ......... ~....., .... ]9.....~...1... ,u~rrl~ ~ i~ol~{~ignature of applicant) /