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Home My WebLink About1834-zI~OP~I N'O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z 3.~00 Date Octo]~e~' 23 19 6:~ THIS CERTIFIES that the building located at l~',/.~..~t,~..i~,V~r..~&~'~i~,. ...................... Street z. o Map No ....................... ~N ....~.*~. ........... Lot No .......................................................... : ............ conform~ substantially to the Application for Building Permit heretofore filed in this office dated .................... ~.~.,;~ ............................. , ]9...~ pursuant to which Building Permit No ........... ]~....~3~, dated ......... ~.~.t.~.,~,~ ............................ , 19.,..~, was issued, and conforms to ~11 of the requirements of the applicable p~o¥isions of the law. The occupancy for which this certificate is issued is ........ .......... ..~.....~..~.=.... ~...~..~....z. ~...~ .~...~ ..................................................................................... The certificate is issued to ....~'t~tll~l~"~t~O~¥ '~1~, ............ . ............... . ........ :',. ............................ ~owner/ lessee or tenant) of the aforesa,id building. FORM NO. 2 TOWN OF $OUTHOLD 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? 1834 z Date .......................... ~1~'.....~ ............19..62,. Permission is hereby granted to: Dan....~eo.~h....A/C...~.... ~Av. oy. .......................... ..... 4th..~t ............................................................ 1. ........... ~s.~. ....................................................... to ...Bttt~d...a~..ackt~.t ~o~. ~.. aa.. ~.~t.i.n~.. ~we~..~.~.n~ ....................................................... at premises located at -..10.t..t~ .............. (~,.~.,.~,t,h.~.~.t...Su-b. ......................................................... ...................................... ~/S....~+t~h..S t ....... J~a~-~et .......................................................................... pursuant to application dated ....................................... ~'t~' '~r'-'"2'~' ...... 1962...., and approved by the Building Inspector Fee $. ~.,,0~ ............. Building Inspector FOR~[ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE .~...~.~'.~. ~::~5 ..~..? SOUTHOLD, H. Y. Examined ................................ , 19.. ,, Approved I ~ ]9 ........ Permit No App,cot on No. APPLICATION FOR BUILDING PERMIT Oote .............. ...... i9 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 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 applica- tion. 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ................................................ (Signature of,2.~,licant' or name, if ~ corporation) ....... ............................................... (Address of applicant) State whether applicant is owner, lessee, agent, a_rc~bitect, engineer, general contractor, electrician, plumber or builder. . ..................................................... Name of owner of premises~...~-~..~.F~ .................................................................................................. If applicant is a corporate, ~gnoture of duly authorize~officer. (Name and title of corporate officer) 1.StreetL°cati°n of land on which~.~propo~ed~ork will be done. Map No.: ...~.:.~:...~~Lot~......-~. No.: ............ and Number ....... ......... ~.~.....~..~..~ ............. 2. State existing use and occupancy of premises and intended use and ~cupancy of proposed construction. a. Existing use and occupancy .~.~ ................................ ~ ......................................................... b ntended use and occupancy ............ L, ...~...~~.: ..................................................... ~ 3. Nature of work (check which applicable): New Building .................... Addition ....~-~_...~..... Alteration .................. Repair .................. Remora! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ........~...~.....~T.~. ..................................... 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, specify nature grid extent of each type of use .................................... 7. Dimensions of existing structure~, 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 .............................. Rear .................................. Depth .............................. 10. Date of Purchase .......................................................... Narne.~f Former Owner ............. 11. Zone or use district in which premises are situated..~,/~......../.~ .............................................. 12. Does proposed construct on v oatean¥~1~ ' __z°n no law, ordnance or regu at on? ............ ~D.' ............................. iiiiiiiiiii 13. Name of Owner of premises .~...,.~...~..D.~...~..D.~.. .......... Address ................................................ Phone No Name of Architect ...~ ..........~, ............./, ................. Address., ............... ~ .......................... Phone No ................... Name of Contractor ~.~~ ............... Address .....~...~.....~.....~ ......... Phone No .................. PLOT DIAGRAM Locke 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 ~ccording to deed, and show street names and indicote whether interior or corner lot. STATE OF NEW~,'3t~/ ~/....~~ - bein dui sworn de oses and so s that he ,s th ............... ;:'; .......... 7'""; ".",'"';"~:'";"";'"'"'; .......... ; ................ g Y P y ' · app cant ,,~ame o, inaiv,auot ~~.) above named. He is the .......... ~....~.. ............. ~ ::...~.~.: ............................................................................ (Con,actor, 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 sta*ements contained in this application are true to the best of his knowledge ~nd belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............... f /7-- ......... Notary Publ'c~~~.~Coyn~ ~J ~"~;~'-c;~al~l~/i~;t) ........................ ............ ~