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Home My WebLink About1303-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...Fr..~,..~. ........... Date .................. Q~.t,O:be~...23 ............. , 19.G~I.. THIS CERTIFIES that the building located at tl~.g..?ZOl~llg~..J~.~a,~...F~.f~,5..~,tt~,,l~ ........ Street Mop No ....... ~.ee. ........ Block No ........ .~e.t ....... Lot No ........... ~.~, .......................................... .. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................... ~.e~IL~t~a~x..~3 .................... , 19..~[. pursuant to which Building Permit No .......... ~...3.3~3 dated ......... F.e~'.v.a~r...23 ................... , 19,...GZ, was issued, and conforms to all of the requirements of the apR][icable provisions of the law. The occupancy for which this certificate is issued is ........ ......... ..................................................................................... The certificate is issued to ...... .~...~..~...~..]....e.~'..,.~,..~..e.~.k..a.....E..~...~..a...~..e..~....~.~. .......................................... (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWH OF SOOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS ~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1303 Z Date ............................ -~eb~:.~aa-:~¥. ,,27.,- 19....~.1 Permission is hereby granted to: ....... S~:~mley...SieJka ...................................... ....... ~z~ l~..R~1 .................................................. ........ ~. ,~,'~Jz~.~c~ r" ~ew.. yo~rk .......................... to .......... ~U ~.~ c% ..n~w.. one .. famX l.y... ~ell/ng ............................................................................ at premises located at ..~/~...X'Q~D,g~...A~.~l,~.,..~.~.~.~..14.C~,....~..e.~....Y..o..r...k. .............................. pursuant to application dated ............................. ~.~.:~.~...~.~...~...3. ........ 19....6..]:.., and approved by the BuiJding Inspector Fee $,..~.0.,..0.Q..~.$d cash Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL£RK'S OFFICE SOUTHOLD, N. Y, Approved ........................................ No ............................... U~ .............................................................................. ............ ........................ ........................... App,icatio. ............ Date INSTRUCTIONS o. This application must be completely fiiled 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 adioining premises or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this Iocotlon. 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 far any purpose whatever until o Certificafe of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 Lows, Ordiaances 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 I~ws, ordinances ond/?regutations. ~ (Address o~ applicant) N ~tate whether applicant is owner, lesse~ agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... .......................................................................................... If applicant is a co~orate, signature of duly authorized ..... officer" (Name and tide of corporate officer) Location of land on which proposed work will be done. Mop No: ..................... ,~...~... ............. Lot No: ................ -- ' ......................................... State existing use and occupancy of premises end intended use and occupancy of proposed construction: a. Existing use and occupancy .............. '~,'.~.'E~f~,.~,~,,~.....~..d,~,,.,.~ ............................................................................ 3. Nature of work (check which applicable): New Buliding ...... ~.,,, ....... Addition .................... Alteration .................... Repair .................. ~,Rg~ovol .................... Demolition ............ :: ...... Other Work (Describe) .................... 4. Estimated Cost....../.,,ct,,....~?...~..~.,, ................................. Fee ..... ............................................................................. (to be paid on filing this oppIication) 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 ................................ 8. Dimensions of entire new construction: Front.......~..~.,.(? ........... .... Rear ........ (~..~ ............ Depth, ......~...~.~, ............... Height ............................ Number of Stories ...... ~... ................. 9, Size of lot: Front ........ ./.,~,.~.~, ....... Rear ,/,.~;)0 Depth ' .... · ...................... i .......... ....... i,.,.- ............ ]2. Does proposed construction ..~., ~'-/~vi°~te any zoning Jp~, ordinance. ~.~//ar regul, a.b~)i)? ,...,k~.~ ........................................ Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone 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 blo,:k numbers or description according to deed and show street names and indicate whether interior or corner lot. STATE OF NEW )¢0P¢~, ~./~ ) S S COUNTY OF .~..), ' ................... ~~.,,~...._.~.,~¢~.., .........................being duly sworn, deposes and says that he is the applicant (Name of indi~/idual sig~_Lng appllc~atior~ __ above named. He ,s the ............... ......... ....................................................................................... (Contractor, agent~ corl~orate 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 I:)~st of his knowledge and belief; and that the work will be performed in the manner set forth in the application fi,~he're)~ith. Sworn to beforg me this · ' ~ : "~' : 1~(~/~ '