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Home My WebLink About1552-zFOEi~{ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..Z..~I,.~. ............ Date ...................... Ap~..~l.....~ .............. , 19.62.. THIS CERTIFIES that the building located of ~/.~..~..'.ttl~e..~e~k..,~o~d ........................ Street Map No. :~r~ ............ Block No .....Y,~;,~ ........ Lot No~g[,~:~ ......~g,¢~O~,~).....,~,.~, ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. ~o~t, em]~......~,)~ ..... 19.(~!j.. pursuant to which Building Permit No..~.~'.2.. dated ........................ .l]~:t&~be~...~ 19.(~,~,.., 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 .......... ..... Pr.i.v.a~e.. ~r~ ..~r~l~...~&l£ng.....,,: .................................................................................. This certificate is issued to ..~.~,:{~.~&F~.~,...~.~'.~ .................... 0~-~ ............................................ (owner, lessee or tenant) of the aforesaid building. H.D.Approval .......................... ................ FOI~M NO. 2 TOWN O~ $OUTNOLD BUILDING DEPARTMENT TOWN CLERK:S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 1552 Z Date ................. BeptJab~.....~ ......... 19~... Permission is hereby granted to: Levis..~as.~woo~....&l.C...~...a~a~k ............. ........ · R;Lv®~h~ad .................................................. to ........ Bu~ .~&. m~w...or~.. ~.a~i...~.. ~et.1..~n~ .............................................................................. at premises located at ...~/'.~.....P.~.II~..~e~..J~M~ ............................................................................ ........................................................ 8outh~ld ..................................................................................... pursuant to application dated ............................. ~e~¢~llbe~.....Xll....19....~.'l and approved by the Building Inspector Fee $.iQ. OD .......... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, lq. Y. Approved ....................... J.l .............. , 19 ........ Permit No ................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Dat .............. .............. , ,d..! .......... 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 application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this ~pplication, the Building ~nspector wiU 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 pa rt 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 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,r .... ................................................... (Signature of applicant, or name, if a corporation) ...... ....... .................. (Address of applicant) State whether appUcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises~_......~....~ ....... ~ ....... ~~ ...................................................... If applicant is e corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No: ...... .~.....~....._.Y~. .................... Lot No: .~....~.. ............. Street and Number ~' ~ ~c,~,.~ ~:r~c_~ ~ ~ Municipality 2. State existing use and occupancy o! p~mises and ~i~?~,~d use and occupancy of proposed construction:' a. ux~s~lng use aha occupancy ............................................/'~ ~ ~J,~ 'f ...................................................................................... b. Intended use ond occuponcy .......... ~.~. ..................................................... / 3. NaCure of work (check which applicable): New Building .... ~..)~, ..... Addition .................. Alteration .................. Repair ............... ~... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ....~i~....~.~,.~.k). ....................................... 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, commercia~ or mixed occupancy, specify nature.and extent of each type of use ................................ 7. Dimensions of existing structflres, 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 ....... ~:~..~.. ............... Rear ...... ~.~' ................ Depth ~..~'T./~.,~.., ..... Height ............................ ../.../...(~ Number of Stories.....~'..~.~,~ ...................... .~...~..~.--~....~/..~.~.~. ~ Z~-- 9. Size of lot: Front ................... Rear ....... ~...f,..,~. ...... Depth , 10. Date of Purchase ............ /...Z....~..~.. ......................... Name of Former Owner ....~.~...~,~r~.~.~, .i~.¢~..,~.,.....(' /.~ ....... 11. Zone or use district in which premises are situated ..... ,~.... ~..C-~.&¢.: ........................................................... 12. Does proposed construction violate any zpning law, ordinance or regulation? ........ .~....~...*. ................................. 13. Name of Owner of premises .~....~....~/.~....Address ............................................ Phone No ..................... Name of Architect ...(.~.:~/~..~t~/~ .......................Address ............................................ Phone No ..................... Name of Contractor .~.~M0~'~....~./~d/.~.~.~::(.~..~..~.......Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly oil 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 YORK, ) S S COUNTY OF ........... ~ ....... /~) ' ' ................. ..~.~.~..~.~.~.~.~,....~.~.z , = ~ ~ ? ................... bemng' duly sworn, deposes and says that he ',s the apphcant' (Name of i~Si~d~l signing application) above named, He is the ........... ~ ......................... ~ .............. ~ .......................................................................................... ~~ ~ ~ corporate officer, etc.) of said owner or owners, and is ~ authorized to,perform or have performed the said work and to make and file this application; that aH statements contained in ~is application are true to the best of his knowledge and belief and that the work will be performed in the mann~ set forth in the application filed therewith. Sworn to b~o~e me this ~ .~:~ ~JUOllH T. BOKENj ~5-:"' ~:~-" _ IIJ ~-~ ~'~lic, State 0f N~Y~k ........................~ ~ ~7¢' / '"% ........ q'~' ~ ~ 4;~¢¢s'~ch Notary Public,~.~.,~*~.¢~unty ' (Signature of applicant) RIVERHEAD lNG SUPPLY, CO. .I 1 J