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Home My WebLink About1309-zFOI~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~.,.~g.~.~:.'~..e.~....~.~.~.:..¢....~.~..~.,.~..~.~.O..~.... Street Map No~..~.~ ................. Block No...~.~.* ............. Lot No .................. ~.'~'. ........................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. .~...~..~....~....~. .................................... , 19...6..~... pursuant to which Building Permit No .......... dated ..1~1~¥..2 ................................. , 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 .......... This certificate is issued to ..~.~b,~..~,],.~;~...OW}0.~X'. (owner, lessee or tenent) o~ the a~foresaid building. ouiiaing inspector FORM NO. ~ 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? 1309 Z Permission is hereby granted to: .................... ~ ~..~...c..~ ................. ...~..~..K.l~t ~- ............. .................. ..................................... ~- ~,~ T ~ ~ ~, o ~ ;~/.,/. '. pursuant to application dated , ~ ~ j~ ~' h . ~ 19(~! , ar~J approved by the Building Inspector . Fee $,.~....:~ ........ FOP~M NO. ! TOWN o~: SOUT.OLD BUILDING DEPARTMENT Town C,ERK'S OmCE SOUTHOLO, N. Y. Exam,ned........~..~.~...~.....'..'.~......19' % ~ '~ ~ ........ ~ it No. Approved ....... ~.~.~.~. ........... ~ 19 ........ Perm ..... ~ ...... Disapproved a/c .............................................................................................. ............................... ........................ ~;.~;~..i;;~;;;~ ...... Application No..../.~.-~..'~...O..,.~.. ......... APPLICATION FOR BUILDING P[RMIT ............. ....... 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 Buflding 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ..;~,~ ........................................................................ ~,~- ~.~ o ,~ i.. . (Signature of applicant, or name, if a corporation) ...... .;.~..~.~..,..k..L~..iL: ...... .~.!.~...~.-;..,:~L~. ~. ~...a. ............. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of ,~remises ~~~...... ~U..~..~.~. - If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location af land on which proposed work will be done. MapNo: /~"~(~ LotNo: .~....~.... ......... Street and Number ...~...0~.......~.~..~......~..: ........... ...~...~...~.~ ....................................... Municipality 2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction: a. [xisting use ond occupancy ........ ~ .............................................................................................. 3. Nature of work (check which applicable): New Building .................... Addition .....~.....~.. ....... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............. 2 ............................................... 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, commercial or mixed occupancy, specify ,nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ....... .~...~...'7..: ........ Rear ...... .~...~...:.....~..' ....... Depth ....'~...'.Jz.,.T..?..~ ....... Height ............................ Number of Stor es ............................................................................... Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... /..~.'.,,-~.~ ....... Rear Height ............................ Number of Stories 9, Size of lot: Front ~../.~...~.L..~.... Rear ............................Depth 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............. : ..................................................................... 12, Does proposed construction violate any zoning law, ordinance or regulation? ...~....0. ........................................ 13. Name of Owner of premises..,(~..~~...~. ........ Address ............................................ Phone NO ..................... Name of Architect...!.~.~.~..~.....c~....~_.~.:~ '"~/) ................ 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 block numbers or description according to deed, and show street names and indicate whether interior or cornel; lot. STATE OF NEy Y~)/R.K,~6,. ) S $ COUNTY OF ~~ ....... ) ' ~: ~~'"I"L-'~Z..~mT... being duly sworn~ deposes and says that he is the applicant ........... ' ........ aaove nam a ........... ~r ................//I ............... ;~Contractor, .................................... agent, corporate' ............. omcer,?;: ...... ~'"~c.~ ........................................ of sa d owner or owners, and is duly au~orized to perform or have performed the said work and to make and file th s applicat on; that ail statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the re<tuner set forth in the appl cat on filed therewith. Sworn to before me this ~ . /'/ SJ~DITIt T. BOKEN .................. ~.... ~ z '~ I/LO--~_ ~ N¥~ry I~J~)l~, State of New York (S anature of .aoolicanth aoy..,o, ..... :-.;...-~,-;~,-.,,7! .... [~.~z:~.~',¢~3, Stff[olk CounLy.f,,.~ /~' -.~*-%/' //~,-' /'/' Notary Public, .~¢-,~¢¢~¢~.~r....~/-~r..'~.a~fr."~m"...b~uur'~' C~/L~ ---