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Home My WebLink About785-zFO~ NO. 4 TOWN OF SOUTHOLD I~U~LDX~G DEPARTMENT TOWN CLERIC'S OFFIC~ SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........... ~...7.~.6.. Date ................................. July..21 ......... 19.6.0' THIS CEI%TIFIES that the building located al .e/lt~..lqa~Sa~i...~l~intl;,,.l%c~.~.~_.,(~i:cho~eet Map No ....................... ~ oc ~o ..................... ~ .............................................................................. conforms substantially to the Application for Buildin~ Pcrmit heretofore filed in this office dated .............~S~..I ........... , 19~.9... pursuant to which Building Permit No ....... Z...~.8~ ..... dated .............~.~S%..$ .............. 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 Th~s cert~ficale ~s ~ssued to ..................... F~ ................................................................. eA~'~ (owner, lessee or tenant) of the aforesaid building. Building Inspector 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) No. 785, Z Date ......................... ]Ag,~JJ~......~ ............ 19.~..~.... Permission is hereby granted to: w~:z~er ~,,~....z.~...?../.~ ....~..-..-. ................................... ..... Gt~wo~.. ~,T~I ,~4~g.. ,.... ~.,~.: ........................... to ...B. ~.. ~.e.."....o. ~.e... ~.t..ZL..~.. ~..~.(.~.?..~..~.?. ............................................................................................ at premises located at ][~t..~. ............. ~J~.~l~i~l~..~,~$...~...J~)..~.¢.?..~..~..e..~. ............................................ ....................................... .~./.s...~ ~ ~.,...~L ~?.~.~..,.._ ~.~?_~:.....~:~:. ........................................ pursuant to application dated .......................... AJ~I~.~....~, .................... 19~.~)...., and approved by the Building Inspector Fee ~.O.~.g..O. .............. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S oFFIcE SOUTHOLD, N. ¥. Examined .......... .~....:. n.,~ ................ 19,~, ..... Approved ........................ : ............... 19.::.....Permit No. ~' Disapproved a/c .................. ~ ................................................... ::.::.:. ................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ......................... AUgZzs.t.... 2,, ................ 1 9..~.c). ...... INSTRUCTIONS o. 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 end of buildings on premises, relationship to adjoining premises or public streets or areas, and giving o 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 shell have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuanoe of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lews, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or ~or removal or demolition, os herein described. 'rhe applicant agrees to comply with all appUc~ble lews, ordinances and regulations. ..... ~l.~er..~l. I~e ............................................................... (Signature of applicant, or name, if a corporation) ......... Gl~n~oot. If~,D~,¢,.... ~,.I, ......................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................................. ! ............................................................................................................................ Name of owner of premises,.,,,,~'~,~,,,T/~i'~,~,,.l~,e~,t,t~A ............................................................................................................... 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. Map No: ~.8.~..~0.~..~...~, Lot No: .................... Street and Number .~/~..~.e.~.~.~Q$~..~ .................. ~.~Q~e~....~= ........................................................ Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy......~9~.~..~ .................................................................................................. ~ ...... b. Intended use and occupancy....~..¢:~)~..~9~$~g~ .................................................................................... 3. Nature of work (check which applicable): New Building......ZZ .......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.....]kl~$000 ............................................. Fee ..~.0~00 .............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........~O~ ................. Number of dwelling units on each floor ............................ If garage, number of cars ........~ ............................................................................................................................. 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.....~6~ ............. Rear .~L.6, .............. Depth .40.L~ ............... Height ............................ Number of Stories ..... ~ ................. 9. Size of lot: Front ...~ .................. Rear ........... ~00 ...........Depth ..~ .................... 10. Date of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated ....... ~u"~O~ ................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premfses.~..~ ............... Address ............................................ Phone NO ..................... Name of Architect ...... ~.~ ............................. Address ............................................ Phone NO ..................... Name of Contractor~¢~..~..],~ ....................... Add ess ............................................ Phone NO. PLOT DIAGRAM Locate c[eariy and distinctly all buiMings, whether existing or proposed, and indicate all set-back dimensions from property iines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ) S S. COUNTY OF ..~l~.f.O;l]~ ........ ~...) ...................................... l~,~la,.~r~,]~.., ....... ; .......................... being duly sworn, deposes and soys that he is the applicant (Nome of individual signing apph'cotion) above named. He is the ....................... 0ol;,~.~-t~o~.~,..$~n% ...................................................... ,' ........................................ ~ (Contractor, agent, corlborote 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. Sworn to before me this ~///J~,~j.~ O, ........................ day of ..: ............................. ~ ...... ~19 ............ .,mini ? i~/(J~iigna~ure'"~' ' -or' appdcan~