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Home My WebLink About1045-zFO,P.~ N~O. 4 TOWN OF SOUTI~OLD ~U1LDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD. N, CEI~T1FICA'I~E OF OCCUPANCY No ...... ~..B53 ...... Date ................. 0ct:obe~c..20 .............. , THIS CERTIFIES that the building located ai .M~n..*Roa.~-..Or.~en~...*New.*¥ork Street Map No......~..~ .......... Block No......~..~..~........~. Lot No ....... *..*~ ................................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................. ~.~.~.-.~ ......... 19.~.0... pursuant to which Building Permit No..~;..Jl~5 ....... 4ated .......... ~l~./fil 2~.. , 19_60., w.as issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is;' ............................................................ ~'~.,~V~:~;... UZ~... ~r,e~,~- z...~w~ ~'~ra ......................................... This certificate is issued to (owner, lessee or tenant) of the aforesaid building. ............................. 'u.d In.'p c or/ .................... TOWN 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? lO45 z Permission is hereby granted.to: Jotm to .....B~f~-t¢t ..~...adc}i¢.~:c~n..on...~..~i,,~n~..d~e.1.]:~:g .................................................... at premises located at ~..:t.n..~O~d.,, ........ t~:r,2ett~j....~.~ ................................................................. pursuqnt to application dated ................................... .A_~l~t.]....l~ ......... 19.~(~., and approved by the' Building Inspector Fee FORM NO. ! TO%VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... .~. ~'.{~...?....~. L...., 19...5...°.. Approved .................................... , 19...~l...Permit No ....... Disapproved a/c ...............~,,~ ~ ~' ~~~~" Application No....!..0....C/..~Z ............. APPLICATION FOR BUILDING PERMIT IN5TRUCTIONS 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 prope,rty must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced be,fore 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,liable for inspe,ction 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 issua.nce 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 alt applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) .................... (Address of o~plicont) /// State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde,r. Name of owner of premises ................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) 1. Location of land on which proposed work will be done. Map No: .......... ..~.../......~.~/'...~...~..~ffot No:....~.....,~f~ .... Street and Number ............. ~ .... ~ ................................................. ¢ ..... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exlstin~ use ond occupancy .................................................................................................................. b. Intended use and occupancy .............. ~..z.'..¢~.....~<..~.,~.~ ................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ...... ~ ........ Alteration .................... Repair .................... Rern~vaJ .................... Demolition .............. ~... Other Work (Describe) .................... 4. Estimated Cost ................ ~..~...~.. ............................. Fee ....... ~.......-~.. ...................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... Z. ............. Number of dwelling units on each floor .................................. If garage, number of cars ............................................................................................................................................. If business, commercial or m~xed occupancy, spec and exten ac type of use 7. Dimensions of existing structures, if any: Front ....... ~.......,Rear ...~.~L/'~/~'~ ...... Depth .....,.,~.~.....~1~"-'"~'"'""; .......... Height .......... ~ .......... Number of Stories ............................ ~ .................. ~ ...................................... ~ .......... ~ ....... . Dimensions of same structure with alterations or additions: Front ....... ~_~......,:~...L/. ..... Rear ..... ~,~..~,...-~..?../. .......... Depth ......~,~........~... ....... He,ght ......... · .~..,~.. ....... ,, ..... Number of Stor,,e,s ..... , ....... ~ ........... ... I /~/ ~ // "._.. I ... z7'/"%"- ' -, ,, 8. uimensions at entire new construction: Front, ...... .~...~ Rear ...~ .... Depth ....../...~'...~.'~ ........... Height ............................ Number of Stories ........ ,./.~ ..................... Size of lot: Front ............... .~.....~.. .................. Depth ............................ Date e,f Purchase ................../'/"~"~ ....................... Name of~For ~me, Owner '"Z ........ ~-~ ............................... i ........ Zone or use district, in which I~remises are situated ................. ............ ~...¢..~1~. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~ ...................................... Name of Owner of premises..i~.~-~/(~.".~..~,.~,~ddress ..... ~-.../..~ ........ Phone NO.~.-...~.:....~ Name of Architect ................................................ Address .................... .~ ..................... Phone NO ..................... 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. 11. 12. 13. STATE OF NEWarK COUNTY OF~/~.) ' · ................... ~.~:~z..~L.: .......................... being duly sworn; deposes and says that he is the applican~~ (~e of individual signing application) (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. .~,./ ~otorv ~ublic, ~~~ ~.,~ (Sion~turo o* oppl~c~nt)