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Home My WebLink About1005-zFO~P~ ~0. 4 TOWN OF SOUTHOLD BUiLDInG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, It', Y~ CERTIFICATE OF' OCCUPANCY Z69~ rate .............................. ~e.....3.0. ......... _~9..6..0. THIS CERTIFIES that the building located a~ .....~../~.... $~;~.~..1. i~g. Road ................... Street Nassa,~ Map No ....................... Block No ..................... Lot No...130 ......... .C~chogue.~......N,.Y, ................... conforms substontially to the Application for Building Permit heretofore filed in this office dated .............. !.4..a..~..~..h--..2..~ .......... 19....6..0.. pursuant to which Building Permit No....g..2t, t30.~ ..... 4ated ..................... :M~.~.?.t~..~2......., 19...~0., 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 ............ ~.~:.'i...a.~.....o..n...e.....r...a..m...:!&~,...a.~lla.~g ............................................................................................ This certificale is issued to ~lOr~ ;B 'ffa.gi;~ (OWrm~'.) ............................................. (owner, lessee or tenant) of the aforesaid building. Building Inspector FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPART/'~ENT 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? 1005 Z Permission is hereby granted to: /zU....~ ..o...~ ..................... to ............................................................. ?...-¢.~ ......................................................... pursuant to application dated ~" ~'~ ~ , 9 ('' 0 .............................. ~ ........................................ , and approved by the Building Inspector Building Inspector / FO~M NO. 1 TOWN OF SOUTHOLD .. BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Examined ........'. ~/. ~.~..~..~?. ~ .~'¢.. ~.',~ 19..(~'~/ Approved .........~¢~.r../~,.~..~ 19..,~(/?..~..Permit No ..... ~..~..:..~...-.~'.'..~-..~... Disapproved a/c ........................................................................................... ..................... (Building Inspector) Application No. ***/~,.,~.,,c?,,~,_~,),,.~ .............. 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 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 of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises ava.ilable 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 shall 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 Ordinonce 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 a I 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. ................................................. . , ,. ........................................................................................................... Nome of owner of promises......~¢.~ ......... I~.~ .......... ~..C~,~.: ............................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work wJlJ be dane. Map No: . '~,~t~ .... ~ ...... Lot No:.,l.~..~ .......... Street and Number .~...~:~:~,=~,v...~g~.,,,.,~ .............. ~,)~,,,~.~:,~.....¢/;.~, ............................. Municipali~ State existing use and occupancy of premises and intended use and occupancy of proposed construction: ......'/7' 4 ~ · 4.,...,..-----------------~** ~k~ ........., 'Vcz ,~.~., ......................................................................... a.Existing use and occupancy ~..,, b. Intended use end occupency ..................................................................................................... 3. Nature.of work~ (check which applicable): New Buildin~ .................... Addition .................... Alteration .................... Repair ................... ~Remgval .......t~ .......... Demolition ....... ~,. ......... Other Work (Describe) .................... 4. Estimated Cost ............................................................ Fee ..L ........ ~ ............................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling un ts .......................... tNum~er 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. u/me s'ons or ntire new construction: r o t ............................ ~ear ............................ Depth ............................ Height ............................ I D,~ Number of Stories ................................ 9. Size of lot: Front ......... ]')"~'9 ....... Rear ............................ Depth ....... 10. Date of Purchase ........................................................ Name o,(~gFmer Owner ............................. ~ .......................... 11. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construct on vJol~e any zen ~ar~w, ~rdinance or regu orion? ............................................... ~'~--e of ~'ner of rems ?/1,)~ ~.~ ......... 13. .~,, uw p~J'{~ ~., t~. ~~" e%..' .................................... Address .......................................... Phone NO ..................... Nome of Architect .~:.~(:.7~,TJ~:~J~$~7, ................. Address ...~..~....~ ....................... Phone NO ..................... ~ame ut ~onrractor ....................~ ...... ~. ......... ~aaress .m. ............... : ................. ~none ~u ....... 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 corner lot. STATE OF NE~Y~)DI~/~, ) S S ........................... ~.../.( ........ ; ............................. '(. ....................... being duly sworn, deposes and says that he is the applicant (Name of individual signing opplic~ti,o~ above named. He the .................................. ............................................................................. (Contractor, agent, corporate officer, etc.) of soid owner or owners, and is duly authorized to perform or hove performed the said work and to mak,e~,pnd file this opplication; thor all statements contained in this application a~e true to the best of his knowledge and that the work will be performed in the manner set forth in the application filed therewith. Sworn to be ore me this .,2~,,,;~, ~ , ?~v ¥or~ ,,-'.d ,~ _ ~, // Notary Public/,~¢.CZ.(Z~..,.~..:,,d~'.~.~.f.-;'~r-~... County . (Signature of apF~t~nt)