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Home My WebLink About1191-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........ ~...~;~. ...... Date .................... ~TJalm,v~..23 ..........., 19.&;~.. THIS CERTIFIES that the building located at ....~..~....~...~..?.:..,..._~...0~...~.~...~.. Street Map No.JL~.JelJLIJll~lJ~.... Block No....e..?..e....~. ....... Lot No ...... ~,J. ......................................................... conforms substantially to the Application for Building Permit heretofore filed in this office doted ............. ~11~1~..~¢~ .............................. , 19..~1d1~. pursuant to which Building Permit No. B..~l~[.. dated ..~Al~.t~...~l. ........................... , 19....~, was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is .......... This certificate is issued to ............................. ..~...~.....~....~....~'..~.~..~.eJ~.~....l~l~l~ ............................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDIbiG DEPARTMEbiT TOWbi CLERK'S OFFICE SOUTHOLD, bi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 1191, Z Date ........................ A~/~'~, ........ 29 ........ 19'60" Permission is hereby granted to: ..... Gr aee-.-B.,...N~-ek-tes .................................... .......... ~outl~ot~i......~.;.¥.; .................................. to ........ Buil'd"~" new' one'- fa~l-ly" dwe:~l~_ng .......................................................................... at premises located at ...i~;..T~.i.....Blo. cl~.2.~...~e~.don..~stut~s ........................................ ....................................... tL~sh'~o~a~u'~ "~v~'~ ....... ~ou "h~ Id' ~"' ~; Y ;' ........................................ pursuant to application dated ............................. ;~l~gl:l~;"'"~ ........... 19..60. and approved by the Building Inspector Fee $.t0-,.00..~$d f Lid~ding Inspect6r ''- FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .~.~..~ ,~/~.~ -~ .......%: Approved ..... ~../.f .~.~...(~...~.,..~.. ] 9....~.; .'Pe r m, t No ....... ~ ./-C/../..~./. .... Disapproved o/c .............................................................................................. Application No ..... .~..,~. ,,~../.. ........ APPLICATION FOR BUILDING PERMIT Dote .............. ~.~-. ........ ..~...~ ............ 19...(~..O. .... 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 Iocotlon of lot and of buildir~gs on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is port 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 o 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 port for uny purpose whatever until a Certificate of Occupancy shall hove been grunted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 Iows~ ordinances and regulations. .... ........ ...... ................. (Signature of applicant, or nome, if o corporation) ........ ............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is o corporate, signature of dulv authorized officer, (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ~,~c,.~...........~....T. ..... Lot No: ..................../( ~n/c- Street and Number ...~......~r..~~...~..~...~..! ............... ~....~..:. ................ Municipality 2. State existing use and occupancy of prern~ses and intended use and occupancy of proposed construction: o. Ex~stmg use end occupancy .................................................................................................................................... b. Intended use and occupancy......~..C~':.':~....~.~.~...~-,'~.~.,~ ............................................. 1 3. Nature of work (check which applicable): New Building...,~...~'t'...'~......Addition .................... Alteration .................... Repair ....................Removal .................... Demolition ....................Other Work (Describe) .................... 4.Estimated .................................... Fee ............................................ (to be paid on filing this application) S. 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 .............................. N~3ber of Stories ...................... 8. Dimensions of entire new construction: kront ........ :.~....,~,-~... ....... Rear ......... ~ ...... Depth ..... ../~...~ ........... Height ............................ Number of Stories ....... ~ .... 9. Size of lot: Front ..... .."~..~' ............... Rear .......... 2...~.. .......... Depth ...F-~.~.~..~ ......... 10. Date of Purchase ........................................................Name of Former Owner ........................................................ l l. Zone or use district in which premises are s~tuoted ......... 12. Does proposed construction violate any zoning Iow, ordinance or regulgtion? .................................................... 13. Nome of Owner of premises..~....~..~...~MAddress ...... ~..~ .............. Phone NO ..................... Name of Architect ...... '~ ~ --~...~....~..~...~':'~.....Address ...... "~") ~.'~..] ........................ Phone NO Name of Contractor......~.....~....-r~........~....-~.'....~(....~.."~ ~)~' ........ Address ....... ~'..~...: .......................... Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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. COUNTY OF ..'-~e~../3-z~....: .......... ) ' , (-~'L_~,.J..~(_ ~ -- -- ~ /~"~ c'~/r-'~ ' rn e says is ....................... ~....~ ............................................ being duly swo , d poses and that he the applicant (Nome of individual signing applica/~n) ~ above named. He is the ................................... ~..~,~~..~.......~..~-~.: ........................................................ (Contractor, agent, corlborate 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~oforth in the applicatic~r-'filed therewith. Sworn to be~le~me this ~ ,_ ~,'~/,,~ub~t~. ~0~£~ pu e,~rlm, nf ~~,,~,.~...3~;?..?!~e~,,,,//~;;~;~''~~Z~°~n~t~'' ~'?~ '~'~/ (Signature of apphcant) Notary