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Home My WebLink About1109-z TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N, CERTIFICATE OF OCCUPANCY No. ~...~.~.Q ............. Date .............. ~e~temb.er...6, ............., 196EL... THIS CERTIFIES that the building located atN~.~...I~.:IY~.~T~,.~,],V.f~,.6~..AmJ~;[il..JJD, a.~ ....... Street Map No..P..e...c,o...n..:L~ ..... Block No ....................... Lot No...O.~f~.e.~huO~.~;~..~.$.~L..'~'~'~.....~.O.t~...~....~? ~ay ~tates conforms substantially to the Application for Building Permit heretofore filed in {his office dated ........................ .~I[/]ftl~...1.~ ....................... , 19.~0... pursuant to which Building Permit NoZ~...ll09... dated .............. .J..v,J~.e....~I..~ ..................... , 19..i~.0.., was issued, and conforms to all of the requirements of the app[icabie provisions of the Jaw. The occupancy for which this certificate is issued is ........ ..................... l~.u~ ,%ne~.a ..hull dtn.~ ...~h~lm.} ................................................................................. The certificate is issued to .......... i..O.~.~.o.....C,~.a..~.a.. ............................................................................ (owner, lessee or tenant) of the aforesaid building. ..... ~ ....... :.{...,.~ ...................... ;.....~ ............................. Building Inspector 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? 11o9, Z Permission is hereby granted to: Xer~i~ Bird ......................... O~e.euD~r.t .................................. to .. ~.%~...~ .. A~.~ ~.~..~ ...~n...~lng.. ~-~ ....~i~e~.~.. ~ ~ n8 ..................... .... ~...~2~.~...~.,~.~r.~...~...~.~..~..~.~). ................................................................ pursuant to application dated ....~ .......................... ~....~ .............. 19.~.~.., and approved by the Building Inspector ~ T ~ BuildTng Inspector Examined ~ t ~( Approved .................................... , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. AppJication No ...... !...(....0...~ ............ Disapproved a/c ...........~. ........ ................. ................................................... . (Buil~tor) APPLICATION FOR BUILDING PEP. MIT Date ....................... ~~...~.~...., 19..~....C7.. INSTRUCTIONS o. This application must be compIetely 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 coromenced 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 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 issua.nce 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 laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) '/~ ' ~ ~ "~ ~ ~'C,~' ~. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............................. ................................................................................................ Name of owner of p ............................................................................................................................................................. 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:~..i-.).~.'..~..~.~.::~....~'. Lot No:..../..?..i'~. ....... Street and Number ................................................................................................................ .~ .................... r. .......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. ~xisting use ona occupancy ...................................................................... .~ ......................................................... b. Intended use and occupancy .......................................................................................................... ~ ..................... ! 3. Nature of work (check which applicable): New Building .................... Addition..,..~.i ......... Alteratlo~...[ ............... Repair ............... ~.. Removal ~ ............... Demolition .............. 4. Estimated Cost ......~.'..~...O....O. ........................................ Fee ....~... ................................................................................... (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 ................................ .......... ~ ................ Rear ............................ Depth ............................ 8. Dimensions of entire new construction: Front Height ............................ Number of Stories ................................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase .................... Name of Former Owner .................................................. use d str ct n wh ch prem ses ares tuated 11. Zone or ...................................................................................... ~.., 12. -Does proposed construction violate any zoning law, ordinance or regulation? ......... ...A~....O. ...................................... 13. Name of Owner of premises...~.~...~Zg.....~.~..?.....m....Address .......................................... Phone NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor ' ....................... . ............................. Address .......................................... Phone NO ..................... PLOT DIAGRAM Locate clearly and disfJnctJy all buildings, whether existing ar proposed, and indicate oil set-back dimensions fram property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. %1~, '~ STATE OF NEW, cYO,~J( tC ) S S COUNTY OF .,..~..,,F~.1P2/.2; ....... ) ' ' ................................................................................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the d)'-'~ (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 flied therewith. Sworn to before me this