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Home My WebLink About590-zFORM NO. 4 TOV,/N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at....G.~..~.a.,e. ................................................ Stree~t Map No.~.~..~.e.~ ....... Block No ......................... Lot No..~..~.. ........ ~.o.~.h..o.~....~.,. ...................... conforms substantially to the Application for Building Permit heretofare filed in this office dated .............................. .~.~.~.T.q.b.....~ .......... , 19...~.c).., pursuant to which Building Permit No....~...~..~,0. ................ dated ............................. ?~..z.,.,o..~. ........ .2....., 19.,5..~..., 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 .............. ................... ...................................................................................... This certificate is issued to ...}[.e.~.e..~...~.o..e.~.~.:l:~ ...... .(..e.w...~..e.~} ................................................................... (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS F~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 590 Z Permission is hereby granted to: L:~- b..:..~4.....~..~......[:l:.~,.~.~....~.~:~: .~..~:,~.~...m.::.-..:::~: ................. ~ .................. ~,~: ~ ~;:~..., ............................................................................ · ~Z...~ ~--.-'-..., ........ at premises located at ................................................................................................................ ~ >~.~ , ~ ~~,:..~ .................................. ................. ~'?: ........... 'T: ............. ;-7, ?: ~ ~ ~.:~L~., f~ ,.~./....-~ ~:.~.'..~'..I: ~.~ ...... ~.-r..?.>=.:~ ................. .~-.::..: ....................................... ?..~:... pursuant to application dated ........ ~.:...'"' ........... ............ and approved by the Building Inspector to ~ Fee $ ........................ Building Inspector TOWN OF SOUTHOLD JBU'ILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD', N. Exo mined.....i....~... ~.....?.. .......... 19..~.~ Approved ........................................ I9 ........ Permit No ............................... Disapproved a/c .............................................................................................. (Building Inspectgr) APPLICATION FOR BUILDIN(.'~ PER~IT ..... Da t e.....i~.~:C.c.'..~....~ ~. .................................... 19...5.~ ...... INSTRUCTIONS a. This application must be completely filled in by typewriter on 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 coYered 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 l~ept 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 pu~'pose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanee 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applioable 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. Bul].de~ Name of owner of premlses......1'~.~,~,.~..~?.D~.~.~J,]~ .............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of [and on which proposed work will be done. Map No: .~..~'~....~f.~.v..eL~....~...~.°..V..~rSk~ No: ..~..O.~J.~.~L Street and Number ....... ~.'4.~...~:t~.~.I.~.~...~..°.~.C;.~3P.~.~.~.*..,MX. .......................................................................................... Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy ........... ?.~.:~.~..~,~.~...~).¥.zjL~]..;Jj~ .............................................................................. 3. Nature of work (check which applicable): New Building ....... ~f. .......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... .q)oo oo F ......................................................................... 4. Estimated Cast ....... ~,,.~ ........ ~ ..................................... ee (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...~.O.....-!:~^ ............Rear .....8...O...~'..t.... .......... Depth ......... ~.8.....-¢~.1).....1...0,II Height ........ .1.~....J:~..t.~..~.... Number of Stories ....1. ....................... 9. Size of lot: Front .... .1...0..0. ................. Rear ......... ~...0..0. ............ Depth ,,,1.,b. 0. .................... 10. Date of Purchase ....~..e...q.q....1...~..5..8. ................................ Name of Former Owner .......... I.¥..::L.~.l..~.a...m....~y.t~.:4.s. ............... 11. Zone or use district in which premises are situated ......... ~..e..s..$.~.~:.Lt....'L..a..1. ............................................................. 12. Does proposed construction vlolbte anytzonlng law, ordinance or regulation? ............. !.~.9. .................................. ~elez~ Posplsil , ,1, Fisher Dr~ve 13. Name of Owner of premises ........................................ ^claress ..J~t.1;......V.,~,r.~lo~.,...ix]:Z ....... Phone Name of Architect .......................... , .............................. Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Lecate clearly end 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 iht, friar or corner lot. STATE OF NEW YORK, ) COUNTYuOF ...D.~.f.¢II,!~ ........ ,) S S. ~I" ' ~'t ~ '~'~ ~ be'n ~uly deposes and says that he is the applicant ................ bb~....d~.~4~. ................................................ g ~ sworn, (Name of individual signing application) above named. He is the ........... ~fl~ ................................................................................................................................ (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 app cat on; that all statements contained in this application are true fO the best of his knowledge and belief; and that the work w I be performed n the manner set forth in th~li~n filed therewith. Sworn to before me th~s ', ~d ~, ~_ ~ 19 Nota~ Pu ...~ .......................................... ~o ff ~