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Home My WebLink About1767-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ........ ~..~]..~..0, ...... Date ..................... .~.,.o..~...e.~..e..~... 4 lc) J3 THIS CERTIFIES that the budding located at ..~[~/[~g~.~,,...~.~.1~.~...9..~...~. ...................... Street Map No ...... ~.* ........... Block No .......** .......... Lot No ...........~.*. .................................................... conforms substanhally to the Apphcahon for Budding Permit heretofore filed in th~s office dated J~lne 6 197...~.... pursuant to which Building Permit No 2J 1767 dated ...................... ~D.~....~. .................. , 19 ...... .5,2was ~ssued, and conforms to all of the requirements of the applicable prows~ons of the law. The occupancy for which th~s cerhficate is issued ~s ....... PHIVATE ONE FAMILY DW~L~,I~G The certificate is issued to .... P~b~r.t..Her.t~]~l~g~ ..~e~. ......................................................... (owner, lessee or tena,nt) of the aforesaid building Building Inspector FORM 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) 1767 Z Permission is hereby granted to: - ·. ~o~oe~t ...He~.~ ~1~e~.lt ...................................... ........... 30C~'~/oodhu~'l'"Jtve .............................. .............. ~o~t..~.e~.:.erson..~ta¥...L.~.i.~ ......... to ... Bu.4.tc}-.~ew..one...fam. t.l~... O w~]:~ J:ng- .................................................................................. at premises located at '"F~'S'""C.i'a~'k...Ro~d ...................................................................................... ................................................. Sou~he.l-d.t... ~'.,.i'~. .............................................................................. pursuant to application dated .................................. tm'e'""6 ............. 196~..., and approved by the Building Inspector Fee $':1'0'i,'00 .......... ........ L.¥.,~,*t...........~ ; ' '~'' Building Inspector FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved ........................................ , 19.....'...Perm t No. '~' I 7 ~ 7 Application No ............................. Disapproved a/c ..... ~ ................................... ...................................... · ................................. 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 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/ (Signature of opplic.~t, o~t'ame, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................................... Name of owner of premises ....... ~...~.~..~...~../.~... ~.....~.~.~.~..~...~..~....~....~... ................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which 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 ............. ...~...~..~......~Z.....i ........................................................................................ b. Intended use and occupancy ......~..~..~..~.....~.~.x~....~.Z~.~..~.. .............................. 3. Nature of work (check which applicable): New Building ...~..~.. ........ Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ....{i...3~../..~ .................................. Fee ...L.©. (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, if any: Front.....z.z..~,./.~.Z.,'Z..... 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 ..... Z~..~....~...~... ...... Rear ..../.,~.../~../.~C. ........ Depth ..../...'~'....~'.......~....~.-~... .......... 10. Date of Purchase ............/..X~....~.. ............................. Name of Former Owner ..... .~....'~..~..~....~...,~..../~...~.. ..................... !1. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction vij,i~olate any. ,zonina, law, ordnance or reau at on_:> ....Z~....~.. ...................................... 13. Name of Owner of premise~.~,C4~.~.~....Address,,2~c~P'./L/..~..,_____~, Phone N'o......'Z......'~....'~...~.~' Name o Achtect ........... ........ ....... r........~e.........Address ......... ~--.--../...... Phone No ..................... Name of Contractor ........ .~.~.~-...,'~.. ............................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-b~ck 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. I > STATE OF NE~{ ) c c .................................................................. ~ .......... J ................. being duly sworn, deposes and says that he is the applicant (Nome of individual signing oppl~ 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 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 cac~ner set forth in the application filed therewith. JUDITH T, BOKEN Sworn to be re me thru ........................ ®y o ........ l) , '" . J ................. ....................... Notary Public; .~.¢...~...~-~6'.......~;~/~¢yL (Signature of ~__J~ica~/~