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Home My WebLink About1351-zFOI~VI NO. 4 TOWN OF SOUTHOLD B'UILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...I~i/S...~C.~../~Ue...@..A~,~O...D~.~.~/'~.... Street Map No..~ ........... Block No .......~..~.~ ........ Lot No. ~ ....... ~.~.e]..t...~,~.. ......................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. ~..~ ....... 30 .......... 19.~... pursuant to which Building Permit No. dated ....................... {~..~....30 ........ , 19.6,~..., 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 ..~,~,~.~.~..&..~'~...(]~]~. ................. (~'t~g ................................... (owner, lessee or tenant) of the aforesaid building. FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OPFICE 5OUTHOLD, N, Y. BUILDIHG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1351, Z Dote ........................ ~.e~h....30 ............ Permission is hereby gronted to: Alher.t ..&.. ~y...,..Caslae~ .................................. ............... M~tt~tuet~ ~...-.,t~.~.~ ........................... to ..... lSu&.l.d...n~w., one..f..a~.~.t~..d~e~t.:t, ng ................................................................................. at premises located at ..;~t.]~o.-~)l'..~:..]~r~y.....A~ ............................................................................ ....................................................... ~la.tt.i.tuelc.r .., .N,L ................................................................... pursuant to application dated ............................. l~l~h'""~O ............. 19.~.I.., and approved by the Building Inspector Fee $ ~lO..Ofl ........... Building Inspector ELIZABETI~[ A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MAI~AGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New ~ork 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's Office (agency Freedom of Information Officer). One copy will be returned to 'you in response to your request, or as an interim response. SECTION I. TO: (Department or Officer, if known, that has the information you are requesting.) RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply date, fi~le, ~)a~)map[~lnumber, and (-~an~°~therL% \/~o~Pe~'tinent information.) Signature of Applicant: Printed Name: Address: Mailing Address (if different from above): Telephone Number: r~ ,~ L~l ~)[,,~[..~z:; APPROVED APPROVED WITH DELAY* [ ] DENIED* Elizabeth A. Nevilib Freedom of Information Officer Date * If delayed or denied see reverse side for explanation. TOWN OF SOUTHOLD ,BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. ~ E×am ned ........... Approved ........................ '..~. ......... ~.~ 9...~...(..Pormit No.....~...Z...~.....z~.../. ....... Disapproved a/c ............... k/.~ .............. APPLICATION FOR BUILDING PERMIT Application No. / 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 odioining 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 unti~ a Certificate of Occupancy shall have been granted by the Building inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanae 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 regulatlons~ · Mar .................. ....................................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether app(Jcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. owner Name of owner of premises...J~.'0.flr..~..~..~rY.....Cas.z~e~. ............................................................................................... If applicant is a corporofe, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ...Q..t.~.....~.'q...~..~.;~.-.~ ................ Lot No:~'~Y,~Y, ............ Street and Number ........ .................................................... Municipality 2. State existing use and occupancy of pr, emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... .'~a~a~t.....~a.~ .............................................................................................. b. intended use and occupancy ........ .O.~.e....$].a..~.i...1.Y....d..w.~.]~.l.~r~g. .......................................................................... 3. Nature of work (check which applicable): New Building ...... ..~....7~........Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4.' Estimated Cost ........ ~0.~.C)0.0.12/..~ ................................ Fee .......... ].D...0.Q .................................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling units .......o.b.e. ................... Number of dwelling units on each floor ............................ If garage, number of cars ............................................................................................................................................ 6. If business, comme'rcial 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 Stor~es Dimensions of same structure with alterations or additions'. Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ........... 32- ............ Rear ........ .}2 ............... Depth ......2~ ................. Height ............................ Number of Stories ..Q~e ................... 9. Size of lot: Front ..... ,].2.~.~ .......... Rear .....,1,2.~./.~. ........... Depth ...~..~.~./. ............... 10. Date of Purchase ................ ..~..~..Z'.......~.~.....~9..~ ........ Name of Former Owner .... ,[~.,.~lzt, hJ,]k][, ............................. 11. Zone or use district in which premises are situated ...... J]..~.!!...~.e..~$~..e...~.~..9,~ ...................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ D.O ........................................ 13. Name of Owner of premises......~..~....g.~.~.P.~.~. ............. Address ....... .J'v.L~.~J,.t,.~.:~g~ ............... Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor ....... ~.,...,~.eJ, L],~....&..~. ............. Address .............. ~'J,a.t, tsZtzz~k ........ 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 corner lot, /~r'~,?, :; ~ STATE OF NEW YORK. ) S S. COUNTY OF .~.'¢~'.~.C~,],~ .......... ) ......................................... ..~6~'~......~.~' .......................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .................................. g.~T),O.~' ............................................................................................................... (Contractor, agent, corporate 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 appiicat on; that al statements contained ~a~thi~/-0~pli,~.Ofion are true to the best of his knowledge and belief; and 'that the work will be performed in the m.an~/~,~f?'~t~o~ the appllcation filed therewith. Sworn to before me this ~Y eor~. No In52~.~f3folk Co~e~t/Orlf .~0 x,,, ,,f t~o~,,~, , 19 xF'cP~r~ ~a- - (S gnature of app cant)