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Home My WebLink About1689-zFOR~ NO. 4- TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.. Zlk~.6 ...... Date .............. AUg.~.S..~. .... ..1.~ .... 19 62 TH~S CERTIFIES that the building located ~e~.~;. ~1~..~. C~¢~ ivo . Street M~Y~9w. P~k Block No ........ ~ Lot No. 6.~ .... ~O~thold ............ conforms subsiantially to the Application for Building Permit heretofore filed in this office dated ............. ~p~;t~......~. , 19 ....... p~ant to which Building Permit No ..... ~.. dated .............. A~Ptl'""~ 19 ......... ~s issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this ce~ificate is This cert~icate is issued t~e~fi ~i~b~fi~ .... of the aforesaid building. ~.D. ~pprova! August 9~ 1962 b~ ..... ~.~.~~ , ~ Building Inspector FO~ NO. 2 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.° 1689 Z Bate ..................... ~,3, .... '3 ..... 196~... Permission is hereby granted to' ........... ~outtmt~ ...................................... to .;~z/~L~,. ~ew..o~e ~-m~t..~..~e-~..~ ............................................................................ at premises [ocated at ...Z/~..6....~.~j~¥i~...~qL~ ................................................................... .............................................. ~enae%.t s e.. La ................ t~ottthc~[8 .............................................. pursuant to apphcation dated ............................... 41,1~.].....~ .......... 196~., and approved by the Buddmg Inspector Fee $'~0...00 ............ FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......~......~. ........ ,19 ........ ~ ~' ,- " .2. Approved ........................................ , 19..."...Permit No .......... Disapproved a/c ....................................................... (Buil~ .................... APPLICATION FOR BUILDING PERMIT Da~~~'~ ......... ~ ........................ , 19~'.~..~. ...... INSTRUCTIONS o. 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 p remises, 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 application. 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 pa rt 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. /'~ ~lico~' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. N~me ofownero, pre 'se .~....~.~'(_,~'~-~........~..~.,~T..~.~.~..,;IZ.¢,~.~.'~'lC'..~': .............................................................. If applicant is a corporate,~gnature of ~l, uly authorized officer. ~ ~ ' (Nar~e ar~eVtitle of corporate officer) I. Location of land on which proposed work will be done. Mop No: ............................................ Lot No: ..~' .............. Street and I',lumber~,.~,/~.~.t~r..~..,~'~/~...:;.~,,~,/.~.~ .;/.:',~..~/...~..~......~.~..~..~,.~... / rvluniclpality / 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. EXisting use and occupancy ....,~r........% ....... i~--~ '~'~'/~"'~"~.~ ...................................................... b. Intended use and occupancy ..~...~~.~ .................................................................................... 3. Nature of work (check which applicable): New Building z/' Addition Alteration Repair ................. ,.,,~Remova . .~ ...... Demolition .................... Other WorF, [Describe) ........................ 4. Estimated Cost .~.....~/..~Z~.¢~....~ .......................... Fee ............ /...(?....Z....: ............................................................ (to be paid on filing this application) 5. If ~Jwelling, number of dwelling units ...... ._~..¢-.'~(,, ........ Number of dwelling units on each floor ............................ If garage, number of cars .....,~:.....~..,~,¢-2~ ................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: ~:ro~t .......................... 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 ,ewconstruction: Front..i...~...~... ................ Rear ............... Depth ..~...?.. ........... =:~ .... Height ..~.!../.. ............. Number of Stories.....~...-~..~/ ............. 9. Size of lot: Front ....... .,~'...~..,.?. ............. Rear ../...z(...~ ............... Dep h ................... 10. Date of Purchase ............~..~.4~...(Z.~.. ............................. Name of Former Owner~ ................................ : .......... 11. Zone or use district in which premises are situated ...... ~..~.?,~.~).~.~.~..~....2;./.~..~.;:;.: .................................................. 12. Does proposed construction4, x,vi01ate ar~y zoning law, ardinance~._~_._x_.~__or regu, lation? ......~......~.. ......................................... 13. Name of Owner of premises /.~.~:~m,.~..;;..'.' .~/~.~.(:?.~-J:':..Address .~~:.c.:,. ................. N ag. < .~.z .Z...~./../. ~.. Phone '. ........... ~ .................. Address ........... ;,: ............ ~ ................. Phone No ..................... Name of Architect ....... ~// ?~ ;~"/~ ......... '?/ Name of Contractor?,,...,/~.....,,,.....h'.'/.!........': 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. .............. ~..~. ~Z, ~'....' .~... ,~. ~../~'.'~... · · .'~. · ] ........ i.~.~.. ............... b e, ng ~ (Nome of individual signing application) duly sworn, deposes and says that he is the applicant 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 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 therew, i#h. Sworn to before me this iUDTH T. 130K£N . / ............. .'/.......-~... day ~f ....... ~~.:~;,~9..~......~~¢:;.~~ ........................ Nota~ Public ..... ~~~~ - (Signature of applicant)