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Home My WebLink About1489-zFOP~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....F~..~.6.1~ .......... Date ............................. ju.~e,..l,T, ......... , 19...6~. THIS CERTIFIES that the building located at Map No ...... w~ ............ Block No .......,~w ........... Lot No .......... w~ ........................................................ conform~ substantially to the Application for Building Permit heretofore filed in this office dated ................................ -3~.1.~..2~, ................ , 19 ...... 6~lpursuant to which Building Permit No ....... dated ...................... ~'~1.~..2~ ............... , lC)..~[., 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 ........ ......................... ~.&~..~k~...~.~;l:~Y...l~tfJfi~;l:~.~. ...................................................................... The certificate is issued to .....l~.~t,..~...~.q~-.~.q~..~.....~;~...~.q~. ................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FORM 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°. 1489 Z Dote .......................... ,Tull. ......... ~ ........ 19.61.. Permission is hereby gronted to: )1111a~d.8,..l~olloglr ....................................... ......... · ~/®~t,--O. reek...Av® .................................... to .. ~-~..].~... ~ev..ON...~.. ~ ~1, ..~.. ~wet.]..'l. ll~ ................................................................................... at premises located at "W'~'""~B'~"'~'~k'"A~'~ ............................................................................. .................................................... Cuteho~u~ ..................................................................................... pursuonf $o opplicotion doted .......................... ~ ......... i~ .............. ]9.~,.., °nd opproved by the Building Inspector Fee $.'1.0.00 ........... FOI~I NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................................... :.,19 ........ Permit No ...................... ~ ........ Disapproved a/e .......... /......,. ...................................................... i ............ ? ......... z::: .................................... APPLICATION FOR BUILDING PERMIT Date INSTRUCTIONS ': a. This application must beic0mpletely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing Iocati'6n of lot and of buildings on premises, relationship to odjoining premises or public streets or areas, and giving a detailed ~Jescription of layout of property mast 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 pre, raises 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 issuance ora Building Permit puFsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other 6pplicable Laws, Ordinances or Regulations, for the construction 'of buildings, additions or a Iterations, or for removal or derholition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. · .~. Millard S,. P..O. Ilo.~¢ ................................ (Signature of applicant, or name, if a corporation) .'..: ....... ............... ............ (AddFess of applicant) State whether applicanrt/is owner, lessee, agent, architect, engineer, general contractor, electrlcian, plumber or builder. .................................. ;i ......... ,. ...... !..~. ~.~ .................................................................................................................................... f/~ ' · Name of owner o remis,es..,...~,~,Z'.Ct.,~.,...~.~l-'l~: ................................................................................................... If applicant is a ~orporg~e, signature of duly authorized officer. 1. koc~tion of land o hich proposed work will be done. Mop No:~ ................................... kot No: ~ ............ Street ond ~umb~?.~..~g.....~g..~.Ol[..~.~......~ag~O~,.~,~, .......................................................... ~ ' ~unicipolity 2. Stoto existin~ use ond occuponcg o{ premises ~nd intonded use ond occuponcy of proposed construction: · . [xisfino use ond occup*ncy ....... ~.~g~...~.~ ...................................................................................................... b. Intended use and occupancy ............. ~g~...~..~.~g.~ .......................... ~ ............................................. 3. Nature of work (check which applicable): New Buildlng."lj~ ............. Addition .................... Alteration .................... Rep~air .................... Removal .................... ~emo[ition .................... Other Work (Describe) .................... 4. Estimated Cost ...... 6t000...p/~ ..................... 'x.x ............ Fee ..."!.O .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........~ll~l ................ Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................... 6. If business, commercial or mixed occupancy, specify nat,ure 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 ............................Rear ............ ; ............... Depth ............................ Height ............................ Number of Stories ............................ 9. Size of Icff: Front ..."~9~ ............ Rear ............. .~,~J... Depth ....~,,~../~...~00... 10. Date of Purchase ............~.~Q.O~..~D~.O:~ .......... Name of Former Owner .. ...... 0.~.O...J~J,611~.~.....~. ..................... 11. Zooe or use district in which premises are situated..~.l~...c]~.~ .................. . ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... I~ ..................................... 13. Name of Owner of premises,J/~"l'ltl~tcl...~.O~.Ol~l:...Address .....~ll.~...Cl~e~..~l~.....Phone NO ..................... # Name of Architect ........................................................ Address ............................. ~ ............... Phone NO ..................... II Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Loca~e clearly and distinctJy ail buildings, whether existing or proposed, and indicate ali 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. SEE ATTACHED PIP, NS STATEOF NEWYORK, ) SS COUNTY OF .~l~.£~Jf~ ......... ) ' ,,~,~,..,~.......~.~..~.,~_,,~/'/7~ ........ .................... being duly sworn, deposes and says that he is the applicant (~e of individual;'~' --signing applica~'on) above named. He is the.....~e~.,,...b~e~ ............................................ : ............... . ....................................................... (Contractor, agent, corporate officer, etc.) of said dwner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that al 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 ther~pHcation filed therew~h~'~-.-x Sworn to before me this JUDIT, T. ,0~, k'~, / ~':~ ~~/' , ~otarv Public. State of New YoA ~ -" Nota~ Pubhc, · .........~~..~..,.~~ t N _J I I r_l LI t I