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Home My WebLink About1717-zF~R~I~ NOo 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~/~..W~.~,.4~l~l:t~e..~/a.~F ......................... Street ~ayp ~aven @ South~d~ Ixlo ....................... mOCK ,~o ........... ~ .......Lot No..~'.3.,-...-8OuthO;~...N~.Z, ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. A~l~.l.......q~l. .......... , 196~.... pursuant to which Building Permit No...~t.r~t7.. dated .............................. AI0z'.t-~I.....2.~.., 19.62.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for wh,ch this certificate is issued is ........ · l~i~ate...one..~.amiZ:F..~w~ll.in~ ............................................................................................. The certificate is issued to .A~t~S...E,...E~I~.~, ........... 0 e~ ............................................................ ~o~wner, lessee or tenant) of the aforesaid building. Building Inspecto7 F01~ ~0. ~ TOWN O~ $OUTitOLD 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.° 1717 Z Date .......................... A~i-~......~.~ ..... 19 .~. Permission is hereby granted to' W~ll~am..W~llJ.... A/~ ~e~ .lta=.t .................... to .... JhaLld..~,ew..ene..£~1~..d~e1.I~nl~ ........................................................................ at premises located at ...~t,...~-'~.. ~..-JJlJl,%'lJl:l..~Jt---~OlatJ3~T, ................................................ ................................................ t~t,~,.~ · · .~.~ g.~ · · ~s,,v .......................................................................... .............................................................. ~1~ ................................................................... pursuant to application dated ..................................... A]~.:J~.....~]~, ..... 196;P..., and approved by the Budding Inspector Fee $....t0~C~ ....... ' FORM NO. I Examined ~ c~-...~., Approved ~ :,.TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ', ? / .7. / .-[ 19 ........ Permit No...: ........................... Application No.....(..~...?...] ............. Disapproved a/c ....................................... APPLICATION FOR BUILDING PEI~MIT ~ INSTRUCTIONS a. '~ TFiis~appJication must be completely filled in by typewriter or in ink and sabmitted 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 prope, rty must be drawn on the diagram which is part of this location. c. The work covered by this application may not be commenced be,fore 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 ava,liable 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 Deportment 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 w th al app icable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Oo~;r~c~;o~. - bull~Lex, Name of owner of nrem ses .~..~ne8 E ~ ~r~ If applicant is a ear, rate, signature of duly authorized officer. (Name and title of corporate, officer) l. Location of land on which proposed work will be done. Map No: ~..~.~.~.~. LO~ 'No:...J~. ............ Street and Number ~O~ W~a ~ ~V8~ ~hO~ ' ~ >~ ~ Municipali~ 2. State existing use and occupancy of premises and intended use and ~cuponcy of proposed construction: a. Existing use and ~cuponcy ................................................................................................................................. b. Intended use and occuponcy ........................... ~.~...~.~.~ ............................................................... 3. Nature of work (check which applicable): New Building ...... ..~. ........... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4.Estimated Cost ........ ~.~.%.0. P..O.,.¢~ ............................ Fee ...... .~.Z...0.,.0...O. ..................................................................... (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, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, Jf 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 ......... I~ ............... Rear ........ I~], ............... Depth .......... ~..2. ............. Height ....... '...~0. ............. Number of Stories ............ ,~,'~ ............... 9. Size of lot: Front ..... .],.0.0 ............... Rear ....... ],.0.1Ii .............. Depth ...~'1 ................. 10. Date of Purchase ...... ..~.~...~..~.]...~..~.9..~.~ ....................... Name of Former Owner ....~.~,~,~,~,~....~...~,.],~ ..................... 11. Zone or use district in which premises are situated ....... .]~.1~.~..~,(t~.~, ................................................................... 12.LDoes proposed ccknstfuCtlon voate any zon ng aw, ord nonce or renu oran;~ 2~ z~, ~ ~'~ ............................................... 13. Name of Owner of premisesi~J~.l[l, lL~,...[~..~..~. ........ Address ..~'.e~,.[..-~ee~..~,~,,.. Phone NO. Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor .....~,~,[~ll...~l/~.;],,~l ................ Address .~I~'...]~,.~.ILIL .................. Phone NO. J~l..~L~..~.~..~.. PI'aT 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 ir~rior or comer lot. STATE OF NEW YORK ) S S'"" , / couN oP. . ......... ) , /j ?, ....................... .~..[.~.~....~1:...~....~.~,.1~ ....... ~ .................... ~'. ............ ~eing d~ly sworn, depose~ and says that he is the applicant (Name of individual signing application) above named. He is the .............. ~.9.~.~.~ ................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have ~rformed the said work and to make and file this application; that all statemen~ contained in this application are true to the best of his ~owledge and belief; and that the work will be performed Jn the manner set forth in the application filed therewith. ............ ~- ~,~ ~ ~ 2~........ day~ ...... ~=[~ ..................... ~..~. ~,~,~ot . Nota~ Public, .~.~...~ ........ ~.~ ._es~ (S,gnature of apphcant)