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Home My WebLink About575-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CEg. TIFICATE OF OCCUPANCY No....~.~.~. ............ Date .................... AU~Ue, t,....26 ................. , 19~2 ..... THiS CERTIFIES that the building located at..~.'e'~.~o~cl.~.~.~.]~e~..~t~.a~L~..~,, Stree~t Map No. ~,..]~,c~r~e.~.... Block No ...... ~,~ ............. Lot No...;~;~ ......... .0.R~o.g~.et~..~[~,~ ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... ,~.e~../~., 19.5..~..., pursuant to which Building Permit No ..... ~52.~ ............... dated ........................... .~..e~z~r....Z~,...., 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 .............. .............. ~L.~.¢~.. ~..~.~%1,~..~.~.~, ........................................................................................... This certificate is issued to ..fJ~.~,..~iit~r~.,~./.C..J~t~,~e~.~'&~k.~e.~.[~,t~ ...... (.~e~) .................. (owner, lessee or tenant) of the aforesaid building. FOR.M NO. 2 TOW~ 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? 575, z Dote .......... Fe ]~.',.Za~.......I-I-. ....................... 19,~.~... Permission is hereby granted to: ~fra ~...Co~a..B,...Stble~. ................................... ............... .Cutchoyue.~......N.,.~ .......................... to ...... M.0.~. ~...f~ ..~la~tn~...c~ .~.t~ ~.~ ...to.. ~ ~...to~a.tion..on...s~..p~.emi~es ............. at premises located at ...~.~.i~J~..~Oa~t..,[~/~ ....... .O]x~..}~ar. bo~...~ ..................................... ................................................ ~.. ~..u..6~ .o...Z,~.~.....tf.,.~ ..................................................................... pursuant to application dated ................~..~...~..~.,.~..~.~.......~..~. ....................... 19~.~...., and approved by the Building Inspector Building Inspector FORi~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .............. Approved ............. ~ ........................ 19,..'l.....Permit No...~.......~...~...~..... ........ Disapproved a/c .............................................................................................. ....... /.(. ....... ................... Application No...~...~.. ............. APPLICATION FOR BUILDING PERMIT Date ............__ ....... ....... .... INSTRUCTIONS a. This epplication 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 adioining 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 o[ this ~pplicotion, t~e Buildin~ Inspector ~ill issue q Building Permit to the ~pplic~nt. Such permit sh~ll be ~ept on the premises ~v~iloble for inspection throughout t~e progress of the work. e. ~o building s~ll be occupied or used in whole or in part for ~ny purpose wh~teve~ until .~ Certifico~e of Occupancy sholl hove been gr~nted by t~e Buildin~ InspeCtor. APPLICATION IS HEREBY MADE to t~e Building Dep~rtment for t~e issuqnc,e of e Buildin; Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ~nd other epplic~ble L~ws, Ordinances or Re~ulotions, for the construction of buildings, oddffions or ~lter~tions, or for remowl o~ demolition~ ~s herein described. THe ~pplic~nt ogrees to comply wit~ ~11 ~pplicoble I~ws, ordinances ond regulations. .......... ................................. (Signature of applicant, or home, if o carporation) (Address of applicant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. : a~p~ I:(fa :: :: fa°: apr r;c~ci!: ' ~~': ' ':' 'u~::~:~ ......... ~ ......................................... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ........................... ~ ................ Lot No: ..~J ............... Street and Number ~)~ ~C~' /..~./..~..~ ~.~.. Z.~..~..~...'~.. Municipality 2. State existing use and occupancy of p~ntended use and occupancy of proposed construction: a. Existing use and occupancy ........................... ~~'~i~ ........................................................................................ b. Intended use and occupancy ........ 3. Nature of work (check which applico'ble): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe)~...~.....~..,c~ 4. Estimated Cost .............................................................. Fee L.~..'"'....'.....'..: ................................................................... (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 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 ....: ....................... Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ] ]. Zone or use district in which premises ore situated ........ : .................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises,~.~.~...~...~...~...~.....'rm~........~, ddress-- ............................................ Phone NO Name of Architect .............. [/~ ....................................... Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM D)cate clearly and distinctly all buildings, whether existing or proposed, and indicate ali set-back dimensions from property lines. Give street and block numbers or description according to deed, and show names and indicate whether interior or corner lot. ( STATE OF NEW YORK, ) S S. COUNTY OF ............................ ~:)~'~'~ C,X)~L(~-~ 'Y~, -~'~"1 bena (Name of individual signing application) duly sworn, deposes ,and says that he is the applicant above named. He is the ............................................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oil statements contained in this application ore true to the best of his knowledge and belief; and that the work will be performed Jn the manner set forth in the application filed therewith. Sworn to before me this ... ~/~ day of .. . .. , ~ c'o, ~:~8,u Y