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Home My WebLink About1128-z~OI~B~ ~0. 4 TOWN OF SOUT~OLD ]~UILDING ~EPAI~TMENT TOWN CL~ERI('S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY TH~S CERTIFIES that the building located at t~.~;...~o.a~.~...~/~...I~.~l~....~l...o...a..~.... Street Map No...X~....X. ................Block No..~ ............ Lot N'o.....~..~... .......... .0..~.e..l~.t...~..~..? ................... conforms substantially to the Application for Building Permit heretofore flied in this office dated ................~.l.y.......~. ................. 19~..~... pursuant to which Building Permit No....Z...1..1...2..~.. ..... dated ................ A11g.~.~...l~ ......... , 19.~.0..., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... .p~.?..a...~..~.. 9~9..~.a...m..%~y...d.~...~.!.r}..g ............................................................................. This certificate is issued to ..... L~..l~...~.....D..~t.~.~.9.8.~. ................ .O.:~..'~..e:~. ....................................... (owner, lessee or tenant) of the afm'esaid building. FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 1128 Z Date ........................... &~Zl~t~....l_ ~, ...... 19~(~.. Permission is hereby granted to: Leu&.s...Demare m~t ................................................. .............. (~ien.t ¥.....~.,.~., ................................... to ... · ~u&.td...ney .erie. · ~e. ami. ly..t~el.l.i, nt. ................................................................................. ..(...~:Le~m..~....0.t.t,o...V. en~r:L...-...~,,~,.l ................................................................................... at premises located at ~/~P~.~R~i~)~9~.~N/B~f~a$~Ft~d~(~u-~£~Ha~.~s~De~arest) ..................................... O~4.ent.t......N~ ¥~. ........................................................................................... pursuant to application dated ...................................... ~'l.t]:y"'""7' ......... t9.60.., and approved by the Building Inspector Fee $ "10',; ~)O ........... Building Inspecto/r FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined....,(~....~........~. ........... 1~ ........ ^ppl~cat~on mo.....I.I..~.~ ......... Approved ....................................... 19 ........ Permit No ............................... Disapproved o/c a~~...~.~~.~...~.~~~ ............................... ............ ........ ................. /5:... .. ................................... (Buildin~ I~p~r) 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 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 issuanc.e 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 hereir~ described. The applicant agrees to comply with all applicable laws, ordinances and re~gulatLons. C'" '-'~ (Signbt~Lre of applicant, or nome, if a corporation) ........... ............................ (Address of app~t) State whetl~.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. :.:..L ........ .......................................................... / Name of owner of prem.ses.....~..~...~.~.....?~ ....... ~ ................................... ...~..... ................................................................. 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 don~e. Map No: ................... ~.~ ................... Lot No: ..~..~.. ........... Street and Number ............... ~....~,~.~' ........ ....~.....~..~.. ...................................................................................... ' /~i~ipality State existing use and occupancy of premises and in'~'ended use and occupancy of proposed construction: b. Intended use and occupancy.....Z~. ......... ~'~.~',,CL~.,.~.~('..'.~.......~/~i-?-~/.~ ...................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ................. ~..~emoval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost......~.~.../..~....~...~..~....~... ............................ Fee ...I...0.....°~... ........................................................................... (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 rnixed 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 wffh alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... .~....,:~...-....~..... Rear ......... .-¢'...~.~...:...~.. .... Depth ....,L:~...~...?.. ............ Height ............................ Number of Stories ........../. ................ 9. Size of lot: Front ..... /..~..~'... ........... Rear ........ /...~...~... ....... Depth ....... ../.~....0...'~.......:.., 10. Date of Purchase .................. ./....~....6...O. ....................... Name of Former Owner ...... Z.~..c'~..~.....~ 11. Zone or use distr,ct in which prem.ses are s,tuated ........ ~ .......... ' ' -x× ................................... 12. Does proposed consiruction viol,qte ~any zonj, n~ law, ordinance or regulation,? r.. ........ ~'...(~ ................................. ~..~...,.Phone NO.....................~" ' 13. Name of Owner of premls~,~..~..~~d~ss ...~...,~..~..:.~(..~.. Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phane 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 whetl~er interior or corner lot. STATE OF NEW ~'O~K,~// ) S S COUNTY OF ..~.~..) ' ................ ~.Z,. ................. ~. be ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) (~o. ntractor agent, cor~borate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and fi e this application; that all statements contained in this application are true to the best ~,his knowledge and belief; and that the work will be performed in the manner set forth in thee aj~tic~J the~ith. Sworn to before me this -~' ~ ' ~:~--~-c~,~ ~7 da -' ~u'~l 19 (x~ ~~-i~l~natt]re of applicant) ........................ ...... L~ E T& I L J lI TOTAL-- III II II -3 jl L-½1-J [. TOTAL-- Z C ~-/ L /,v,d SHEET-- TOTAL--