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Home My WebLink About1615-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ]~....~F~t'~J..&V~. ................................. Street Mop No ...... ~ ..... Block No .......~ ...... Lot No. ~ ....... J~t,i.t,13~k ........................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... J[O~. ...... ~0 .......... 19.6~.. pursuant to which Building Permit No. dated ........................ lloYelaber.-...[~O 19...~.1., 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 .......... ....... P~. ~,va.t e.. ~..~.aall. y.. ~,wett.~ ....................................................................................... This certificate is issued to ....~L~,~..G.e...~4~$a~.~. .......... 01ffl~J~ .................................................. (owner, lessee or tenant) of the cforesaid building. H.D.Approval April 30, 1~62 b~ R.Villa FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 1615 Z Dote ................. ~l~V4~mbe~..... ~.0 ........... 1961... Permission is hereby granted to: Thomae ,...l~ehe~.....A~..C.....Smith.. G,.- ......... M~% ~.i. t ~,e]~ t... ~ ~. ¥, .................................... to ...... Bu.~.td...~e~'.. ~me...f.a~.t~-. &wel.!.i. ng ................................................................................ ot premises Iocoted ot .~rl~i~...AV~ ............ F~$t.i.t~ek. ................................................................. pursuant to application dated ............................ l~eYe~be.z'.....20 .......19~:1..., and approved by the Building Inspector Fee Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~.~..... 19..E./. Approved ........................................ 19 ........ Permit No. '~---/ ~ Disapproved a/c '""~","4.~.~--~'""~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely ,f~led 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 o 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 Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ......... .............................. '' ............................. State wh~~is owner, lessee, o~ent, architect, engineer, general contractor, electrician, plumber or builder. · L z__- Name of owner of premises ......... ~ .............. ~.~ ....... ~r ......... /..-~.~.: ........................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which pro_posed work ,I~ill be done. Map No.: ............ :..'~ ........................... Lot No: ....L.."~... .......... Street and Number ........ .~..~......~ ............. ~~.....~..~..-'..,~'....C ....................... Municipali~; ~/ 2. State existing use and occupancy of/p/,~emisesl/,q,(/~/,,~4~/~_an/~ended~ use and occupancy of proposed construction: a. Existing. use and occupancy ................. ',-t'¢ ........ ~, ................... ....... :'~ .................................................................. b Intended use and occupancy ...... ,/~.~ ...... -/~ .................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... ,Oother Work (Describe) .................... 4. Estimated Cost../,~. ............................ :.Zi':i.:..: .......... Fee ....7/.¢.~ .......................................................... ~ ./' (to be paid on filing this applicati~) .......... - /. 5. If dwelling, number of dwelling unit's ............................ 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 . 8. Dimensions of entire new construction: Front ........ ~.~....-z...~.... Rear .... th .......................... Height ............................ Number of Stories ............................ 9. Size of lot: Front ....... j..~...~.. ........ Rear ............................ Depth .....~....?./.......~?. ..... 10. Date of Purchase ........................................................ Name of Former Owner 1]. Zone or use district in which premises are situated ........................................................................................ 12. Does proposed construction violate any TOn ng aw, ord nonce or renu at on> ~ " 13. Name of Owner of premise ..s~.../.../~.../~.....~.......'~..~..~...f..6..Z.~.Address ....'~..~.~../..~...~'.....'~. ....'~..'~.,......Phone NO4¢/'..~...?....~...~...~..~S- Name of Architect ........................................................ Address ............................................ Phone NO ..................... Cant rac~Z..,~...~.....~. ~ ~..,~... Name of ...... Address...~...~...~..~.. Z(~..~:..~/..,.. P h on e .................... PLOT DIAGRAM Locate clearly end 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 NEW/~'O,,I;~'.,,~,d~ ) S S COUN~'~r' OF .,~,/f,~--c~e~..~.....) ' ....c~..~~..~...~..r....~~ ............................... being duly sworn, deposes and says that he is the applicant (Name oi?,,~dividual signing application) above named. He is the ............................. .~.,~....Z~...~..~..~.~ ....................... ,. ............................................. (Contractor, agent, corlSorate 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 befQre me th~s' "~ ":~U~rT~I 0KEf/ .. 4~.....'=~.... cloy Of ............. ~~,~f&,~..~..f. Ne, Yor, (Si~]Q,ature of applicant)~~____~__,~.~