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Home My WebLink About1652-z{~OP~ 1'40. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...... ~..~..3.~ ........ Date ............................ ~U:le...5 ............. , 19-62. N~Ti~I~F-~ I~ that the building located at ...~..t...?~..~..$...~..g...~.~..:..~.....C'..~...L.~..l~.~?.. .......... Street Map No ....................... Block No e,e~ Lot Nc~.~.~.. conforms substantially to the Apphcat~on for Building Permit heretofore filed ~n this office dated ................................. ?..e...b.~.~....z~......8. ......... 19....6.~.. pursuant to which Budding Permit No .~.....~..6...5..~... dated ................. ~;:~:~':y ..l~.., 19..~., was ~ssued, and conforms to all of the requirements of the apphcable prowsions of the law. The occupancy for which this certificate is issued is .......... ...................................... Wi.. i'i~ ~ .V'~,~...O.{~'tl ~Z-u~i Y~.. IT~__J; T., YJi({ .............................................. Th,s certificate ,s issued to ........ ..J~...~.:...~:...~.,.....lJl..~.?..~.,.....o.~.~..e..~. ..................................................... (owner, lessee or tenant) of the aforesa,d building Budding Inspector FO~M I~0. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1652 Z Permission is hereby granted to' ............ ~tte~o&ue ............................ at premises located at ...~....~t~.~t~.,~..]~t~l~l;l ,~'4a~a~ ........................................ pursuant to application dated ........................ ~~.....~ .......... 19~ , and opproved by the Buddmg Inspector Fee $..~,..0~ ............ FORM NO, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ........ Approved ............./.. ,~,...19.~...'~..Permit No ....... . .~¢...../...~....,~,~',.~-~.. Disapproved a/c .................................. ......... ,..........~-'~ ................. ................................. 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 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 hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe 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 Paws, ordinances and regulations. (Signature of applicant, or nome, if 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.....~.:...'3~.~..:..,~l..,..~....'....~~ ................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on wbch proposed work will be done. Map No: ....~.;.... ...................... Lot No: .................... Street and Number ..~...~ ~.....~.....~../.~...~.~...~....~.,..)?.:~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy......~...,~.'.~ ................................................... b. Intended use and occupancy.....D,~......L~,:~/...~<....~....~.~.~ 3. Nature of work (check which applicable): New Building .................... Addition ....,z~. ........... Alteration .................... Repair .................. ~R, emoval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........ ~....~ ..................................... Fee .............. ~....!..~ ........................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling umts ................................ Numb r 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 ........ l..~q.q ............. 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 ...J...~...~,...~..) ...... Rear .../...~..,~.,../~.~ ..... Depth ....... /...~......~c.. ....... 10. Date of Purchase ........ /...~....~....~. .............................. Name of Former Owner .....'~.:...J~..,~-~~... 1 1. Zone or use district in which premises are situated..c'S,+~.....:...~....~...~..'......-~.. 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~z........: ............................... 13. Name of Owner of premises..~c~'~,~.:.J~.-.~.~ ' . ........................................... Phone NO. . .¢~ Add ress .................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor...k~..~.....~'. ......... Address ..k~q....~..".....~, .~...:~.'.Phone NO. z_ PLOT DIAGRAM Locate clearly and distinctly ali 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. COUN OF ' ...... ~.~.~.~~~ ................................... being duly sworn, deposes and says that he ,s the applicant (Name of individual signing application) above named. He is the ........... ~ .............................................................................................................. (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 app ication; that all statements contained in this application are true to the ~st of his knowl~ge and belief; and that the work will be performed in the manner set forth in the app ication fi ed therewith. Sworn to ~fore me this ~.:~ do~ of /~~2*~,~ew York--- (Signoture of opplicont) .......... ... ..... Noto~ Public,