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Home My WebLink About951-zFORM i~O. 4~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK~'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........ Z5,,~2 ........ Dote ............... THIS CERTIFIES that ther buildln.g located at ....~../.~...~n.~.e..~..~.~...e. ............................... Street Map No .......~ ........... Block No....~ .............. Lot No. ~ ...........G...~..e...e..~.~.o..~.~x...~..,..~..~ ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated 0'~,l~, 7 19..G..0..., pursu.o'nt to which Building Permit No. ~' 953. dated ....................... ~..~..~.. ....... .'/. .............. 19..G.g..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupa.ncy for which this certificate is issued is ................ ......... ~.~ .t..v..~.t...e.....o..n..e.... ~..n.~ .Z. ~... ~.e...z..Z...t..n. f~. ............................................................................... ? ....... This certificate is issued to .......... .~..~..~..e..~.~........~..e..~..~..z'. ............. .(..o..~...~..e...~..). ....................................... , ..... (owner, lessee or tenant) of the aforesaid~ building. TOWN OF SOUTHOLD BUll. DING 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? 951 Z Dote ...................... J,~J~r~.~.~.....7 ............... 1~ .... Permission is hereby granted to: i~aker & ?ioke~sse~....A/C....A;li;~r.~...~r%e~ ............................ ..... J~u.~. J[.I, ............................................. to ...Blz~ld.. a~w.. o~. ~a~il~..~welli~ .............................................................................................. at premises located at ..E/~....l;nte%..I~ ................................................................................................. .................................................. 6r~npor~.i....~.~.y ~. .............................................................................. pursuant to application dated .......................... Janliar~r.......7. ............... 19~0...., and approved by the Building Inspector Fee $. ;ll~.Jg~ ...-. ........ ......./~"~"~ ......................... Building Inspector]'"": ................ :':':'"; ........ ;~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......~~.~.., 19.~....~.. Approved .... .~,¢~¢~-.;~..., 19....~...qPermit No ....... ~.~.~.~.. ........ Disapproved a/c ..................... : ........ ~ ............. Application No ...... ............ (Building Inspector~'J 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 (3 detailed description of layout of property must be dr(3wn on the diagram which is part of this location. c. The work covered by this application ma,/ 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 inspe.ction throughout the progress of the work. e. No building shah be occupied or used in whole, or in part for any purpose whatever until a Certificate of Occupancy sha~l have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance 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 comp y with a applicab e 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) Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... . Street and Number ....... .¢-~...¢..~..~...~...f.c./~......;.~..z.j......*..~..: ....................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................. b. I ntended use a nd occupancy ..../..~......./.~.~..~...~.../.~...¢,../..,..~..~. ~.,~ .~.'..¥..¥,.~..~.....~.. .................................................... / 3. Nature of work (check which applicable): New Buildinfl ..,~ ......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........... ~.,~..~.;..o....o. ................... Fee .....- ..................................................................................... (to be paid on filing this application) / 5. If dwelling, number af dwelling units......~. ................. Number of dwelling units on each floor .................................. If garage, number of cars ...................................... : ...................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and exten~ of each type af 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 ..... ./..~.i ............... Number of Stories ......... ../. .................... 9. Size of lot: Front ..... .~.. ................... Rear .....~....~? ........... Depth ....,~.....~..?.....'~'.. ....... 10. Date of Purchase ...........~.~.?...~. .................................. Name of Former Owner .,./..~./?.,c;~....'.T..~...L...L..!..~ ....................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? .... : ................................................... 13. Name of Owner of premise~/~.~.~..~....~.../.~..~.,~.x~..Address~,/~/~Z~....,~,..*~./.~/zl..~.~ Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor ..,~.../~/~...~./~....~.i ..~..(..c.,/~..~../..~..J..~.~.,'~..Address ~..~..~.~././..~..Z..,,~.....~....~..:... Phone NO. ~.~'".?..'.7...~..~.. 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 corne, r lot. o? .......................... ) · ' .'.',kf;...~..Jk. ............ ~.....C/ ...... ' ................................ b ' g y sw n, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...... ~ ............................................................................................................... (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 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 .~..~.~' ............. day of .............. ~(~19.(ff.~d:., JUDITH T BOKE~ z ~ -~ 5~/ ~~ ' ~otary Pubhc State of New York Notary Public, ..~Z~..~4.~-Co;~tyN~ 5? ',~'473, suf[olk ~i~gtpre of applicant)