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Home My WebLink About1684-zFORM I~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD. N. CERTIFICATE OF OCCUPANCY No.~ ZJ.l~18 ...... Date .............. AtlgllS~ . ~., 19 ~2 THIS CERTIF~S that the building located a! ~y ~h~r~. ~oad .... Street ~aeC~ic Bay Estates. p No ..................... ~]ocx No .... ~ ....... Lot bio. S~' Gr. eenpor$ ............... conforms ~ubstantially to the Application for Building Permit heretofore filed in this office dated .............. ~..SI 19..~ pursuant to which Building Permit No .... ~ dated ........... ~e~. ~, 19.62.., was issued, a~d conforms to all of the require- men~s of the applicable provisions of the law. The occupancy for which this ce~icate is ~ssued is ....~lvate..one fam~.ZM .dwe1!lmg ................................................... This cert~icate is issued to ..P~...EI~ ........ ~e~ ........................ (owner, lessee or tenant) of the aforesaid building. H.D. approval August 21, 1962 by R.Villa Bmldmg FO~ NO. 2 TOWN (~F 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.° 1684, Z Bate ............. ~11~]:1.....~t, ..................... 19~?.... Permission is hereby granted to' to ...:l~.$~..n~..m~..~m~t~Ly.../lw~ini~ ........................................................................... at premises located at ~t~ '~'~ ..... ~.~'"]~/~"~111 ..................................................... ..................................... ~..~..~.~.....~r,~.-~X~t~ ......................................................... pursuant to applicahon dated ................................ IJb~,~....~ ......... 19~..., and approved by the Building Inspector Fee $....~,OOL.I~ Building Inspector FORM NO. 1 To N OF OUT OLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... .....~....~.)./. ...... , 19....(¢....t~ ,, ,, :./. Approved .................................... , 19 ........ Permit No ............. Disapproved a/c .............................................. APPLICATION FOR BUILDING PERMIT /I 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 o 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. Q (Address of applicant) ~/ State whether appli~/~ntis ~/~r, lessee, agent, architect, engineer, general contractor, electrician, plumber or bu der. Name of owner of premises.....~...~.~ ............. ~'. ~.~ .............................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) /7. 1. Location of land on which propos~,cl work will be~ done. Map No: .............. ~......~....,~.....~, ........ Lot No:.....~...7.. ....... Street and Number ...... "~"'~'"'~MM~i:'i:~'"'""~'"~'::~ ........................................ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy 3. Nature of work (check which applicable): New Building... ................. v Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost~....~....~'...~...O. .................................... 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, speci~ n~ture ~nd 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 ........ ~.~..~ ......... ~ear ...... ?~..~ ........ Depth ...... ~/~.:.~.~ ....... 10. D~te of Pu~hase .......... ~-- ............ /.~....Name of Former Owner ] 1. Zone or use district in which premises are situated ..................................................................................................... 12. Does proposed construct on voate any zon ng aw, ord nonce or regu aton? ~ .................. 13. Name of ~ner of premises.../.~.~l~i...~,/I.~ ...... Address .ZZ.~..~C~..~.~..~eJ-- NO ..................... Name of Architect .................................................... ~ddress .......................................... Phone NO ..................... Name of Contractor .~C....~/.~ ..................... Address ..... ~E,~...~.~F~one NO. PLOT DIAGRAM L~ote clearly ~nd distinctly ell buildings, whether existing or proposed, ~nd indicate ~11 set-b~ck dimensions from property lines. Give street ~nd bilk numbers or description ~ccording to deed, ~nd show street n~mes ~nd ~ndic~te whether interior or comer lot. ~/iO.o0 76'.o~.' STATE OF NEW/¥O~ ~ ) S S COUNTY OF ~.)~,,' ' ................ ~ ........ ~ .................................... being duly sworn, deposes and says that he is the applicant (Name of~Jindividua' 'signi~,~,applz_tiT~_,./ above named. He is the ................. ..,~....:~...~,/~c~..~:..~ ............................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or ha~e performed the said work and to make and file this application; that all statements contained in 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 application filed therewith. Sworn to before me this JUDITti T. BOKEN IT0t~ry Public, State of New York '~ '~"~-' k /'~/ ~' Nc., "'~-;34~63, Suffo k County ........... · .~.../.; ...... doy.~of .......... ..,.'~..//...~.,q~., 19t,~,~.l~s March 30, 19~,~ (Signature of applicant)