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Home My WebLink About1360-zFORM NO. ~ TOWN OF $OUTHOLD BUILD$~G DE~ART~E~T TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATe OF OCCUPANCY No...~..].,~1~ ........... Date .............................. THIS CERTIFIES that the building located at .~.I~...O.~,~...F~I.~.~..I~D, aI~I. ......................... Street Map~.~.~....H...O..~..e..~.... Block No...ZSr,,~ .......... Lot No ................ i~O~.h~[61,~.....l~,..~.,- ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. ~aZ~,~I~....~.], ........... , 19..6~. pursuant to which Building Permit No...~,~.~0.. dated ......................... ~a~.e~,......~]~....., 19.~L., 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 .......... Bus/~,~e.~ s.. ~u.~.3~.t~,§..~,.. Re,~,t~tu~n.t ...................................................................................... This certificote is issued to ~.or.f;...o:C...F~y.;pt;,..~a~..&..~iez'~..Z, e2,b;Le;il~....,O~le~'.s ............ (owner, lessee or tenant) of the o,foresaid building. ....... I~'uilding Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT $OUTHOLD, N. Y, BUILDING PERMIT (THIS P'ERMIT MUST BE KEPT OKI THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 136o Z Date ........................... ]'(~r~h.... 31 ......... 19..~1. Permission is hereby granted to: ............. Sc,'~the.ld. ............................................... to ........ Mo~.e..ar~..exis.tin~...~u~inesa.. ~ui~d. ln, g~,.~nd...hu~ 34..~d~l.tion.. ~n s~me ............... to..r~ew...l~c~ti~n ........................................... ~ ................................................................. at premises located at ..... 8'/8'"]~}.~"R'Oa¢} ........................................................................................ ............................................................ -S oU~ol~ ~--....N.,.~.~ ................................................................ pursuant to application dated ....................................... H~:~h.....,~.~....19..6];.., and approved by the Building Inspector (W&H Lieblein) Fee $.10..00 ........... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No...!..~..~...~?. ............ Approved ........................................ 19 ........ Permit No. ~./..'.~....~...~ .......... L.. ......................... (BuildJ~ Inspector) APPLICATION FOR BUILDING PERMIT Date ............... ~.~:~.../~...~.....~.../.....~.~,....... 19 z~z .~.. .... 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 nat 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 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. (Signat,,~re of applicant, or name, it a corporation) ......... .............................. (Address/of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ "/~-~ -- /q ~ .~......~..~.....~~..~..L.....~..~..~d.-.~.:.~.~....~.....~.~..~~: ...... If applicant_ is a,corporate, signature of duly, authorized officer. .... .... 1. Location of land on which,~oposed work will be done. Map Ho: .............................. ~. ............. Lot No: ,....~......'-~b ........ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use end oceuponcy ....................................................... b. Intended use end occupancy........~ ........................................................................................................................ property lines. Give street and block numbers or description according to deed, whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition ......... ../r~........Alteration . .,~.......... ...... Repair .................... Removal .................... Demolition ......... ~, ......... Other Work (Describe) .................... 4. Est mated Cost ..~./.. ~ ~....-~.. ~ ~ Fee~.~....'~.. ........................ (to be paid on filing this application) 5. If dwelling, number of dwelling units....i~%.i]..Ti.....i ........... 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 ....... ..~...~...L ........ Rear ...... ..'~.....~.....[. ....... Depth ....~,...~...~ ............. Height ......J...d~....~ ............. Number of Stories ............. ~:T7-(~C,¢,~<. ........................... ~ ........ ~ .......................................... Dimensions of same structure with alterations or additions: Front ...... ,/~....[. .............. Rear ..... ~..~. .............. Depth ...~...~.....f ............ Height ......... ./....~..../. ........... Number of Stories ........ ~ ............ 8. Dimensions of entire new construction: Front.....~,.~.. ............. Rear ...... ;~......~... ........... Depth ...../..,~.. ................ Height ........ ~...~..,.~ ......... Number of Stories ...... /.,. 9. Size of lot: Front ....'.~...?'.....(~.. ........... Rear ...... .~.....,~......c~., ........ Depth ....~.....~..?-.....~ . 11. Zone or use district in which premises ore situated .............................................................. ]2. Does proposed construction violate any zoning [ow, ordinance q~r regulation? ..... ~ ...................................... 13, Nome of Owner of,pjfimis~..~,~,/~' ~---,¢-- /~ ....... Address ..~,~ .~ / ,~,,, ................. Phone NO..~.?...~'...~...~..~..~,.. Name of Architect~('~,~~....~,~.x ...... Address ..~~..~.O'.~..,...Phone NO ..................... Name of Contractor/~)..~ ........... Address ./~~~.~'....Phone NO.~..~.....~....Z'..~.(~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from (and show street names and indicate STATE OF NEW yO~,,~ ~ ) S S COUNTY OF :.~....) , ' ~~. ~:.~ ............................... being duly sworn, deposes and says that he is the applicant (~ame of individual sig~g application) above named. He is the ................ ~~~ ......................................................................................................... (Contractor, agent, corborate 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 Jn 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 the a~plication filed therewith. Sworn to before me this ~Z ~ day of ~.~,~., ]9,.~...~'~H?. B~~ of app[ican~~~ .................... ~ ~";-'7 "'~ '~ ~' ~ Z,,~'~ ?' ,,tare of New York j[ Jr 2 x/O F/o~r ~rn S -16 3r/dql~q at 4ob C~rnenf L 'l' POMT