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Home My WebLink About1855-zFOKM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~...,1,~.0.~ ........... Date ................... O.~g~..g~...~.~. ............. , 19..I~.~... THIS CERTIFIES that the building located at .].T.f?.~..t~......~..e..~.....~...~.t.x....~....O~.....t~...O...[..~.. ............ Street Map No ..........~e ...... Block No ......... e~e .......Lot No ......... ~a~ ....................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... .l~l. glZJt...[?. ................. , 19...62 pursuant to which Building Permit No ........... dated ................ ~tlg'~lm.t,..20 ................ , 19....~.., was issued, and conforms toall of the requirements of the app]icoble provisions of the law. The occupancy for which this certificate is issued is ........ The certificate is issued to ............................ ~[~f.O.~...~.~....~ ..,~'~....c..~..~.~. ..................................... (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o 1855 Z Dote ......................... Permission is hereby granted to: Geco.1 ~...ff_a~mel.... 4h/O.....l~.grton...~.... .................. /~outhotd .......................................... to. ~l~t ..an.. ~dd~t±on..on..mr..ex~ s~cing..dwe.~.tinE ........................................................ ot premises Iocoted ot ....ll/S..ttol-tlt..8®&...Dl'~re ........................................................................... ......................................................... Southo.ld .................................................................................... pursuant to application dated ............................ A.a:~t.....~l~ ............ 19~,.., and approved by the Building Inspector F~e $"~IOO ............ ~ ·" Building Inspector FOR~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......~'....~ ......... , 19.~....? Approved ........................................ , 19 ........ Permit No .............................. Disapproved a/c .~~ etor) INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or and giving a detailed description of layout of property must be drawn on the diagram which is part of this applica- tJon. d. The work covered by this application may not be commenced before issuance of Building Permit. Upon approval of this application, the Building Inspector will issue a Building Permit to the applic~,nt. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No buiIding 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 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (S~gn~re o~ opphc~nt, or n~me, if ....... ~..¢ ....... ?,..~:..,.~....~.....:.....2....,.~,~¢. ................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....... .......................................... ~-' / -..x~ ' , ~,..~ t.? ............................ Name of owner of premises ...... '...;<!~),Z,. ,~,/.':~...'~.:'~-~2 ....... /..::::: ...... ~..~¢~..¢.&-¢~,.,,~.. ................................................................ .1 0 If applicant is e corporete, signature '6f duly authorized officer. (Name and title of corporate officer) 1. Location of land on which p~,oposed y/ark will be done. Map,.~No.: .~ ....... ~~: ...... i.. Lot No.: .'~..~. ........ Street and Number ..~.. 'L~......~....''c>'~'~ .... ~ .................... ~,..~.. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ............... IL~...~,,~,¢.~..-.....~/:.¢~.~o.~'~,,~,~ ........ ¢. ~,~L,~.~.¢,o~d ............................. b. Intended use and occupancy .................. ~,.[.~:¢.,~¢ ).~....~).....y ..a:':z~.,.~(~ ...................................... 3. Nature of work (check which applicable): New Building. ................... Addition ...~.~Alterqtion .~. Repair. ................. Remova! ................. ~,.Pe~molition ............... Other Work (Describe)..~..~.~..~.,'.' 4. Est mated 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 .and extent of each tyre of use ........... 7. Dimensions of existing structures, ,f any: Front ......... . .~....~.. ......... Rear ...... Y~.. ............. Depth ......~....~l. ................. Height ............................ Number of Stories ............... ~.~M,~ .............. .. . D~mensions of same structure w th aterat ons or additions' Front ..~.. Rear Depth ......... ~/..~ ............... Height ................................ Number of Stories ............ ~ ................ 8. Dimensions of entire new construction: Front ........... ./.~.../. ......... Rear ........ ~.....~....~. .......... Depth ....... ../'....~.. ............... Height .............................. Nuj)qber of Stories ........./.. .................. ' 9. Size of at Front '~. ~ f? .. Rear ............................. Depth .~' O~ 10. Date of Purchase .~ ........... /...~...~.....'7. ............... Name of Former Owner. ~.~, ,~.~..(~ ..... I 1. Zone or use district in which premises are situated .............................................. ~.. .................................................. 12. Does proposed construction violate any_zon nn ~aw ordnance or renu at o~ , ................................ ......... 13. Name of Owner of prem,ses ~..~..'. ..f~,r.~r.~... AddressT~.~.. .. .:f~..~ ........ Phone ~.~.Z..~....?.~-~ ........... Name of Architect .................................................... Address ................................................ Phone No ................... Name of Contractor .................................................. Address ................................................ Phone No .................. ~LOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and ir~dicate all set-back dimensions from property lines. Give street and block numbers or description according to deedt/-~d show street names and indicate whether interior or corner lot. I -- -- ~ t STATE OF NEW~,YO~R~,/~ ) COUNTY OF ~.'.f~.....i S.S. // .......................... //.....--..~..~.. .................... '.~../~...~b 'ng duly sworn, deposes and says that he is the applicant (Name of individual sign~ application) ~ above named. He is the ................ ~~.....~......~.: ~ ~ (Contractor, agent, corporate off car, etc ) of said owner Or owners, and i~ duly authorized to ~rform or have performed the sa d work and to make and file this application; that all statements contained in thi~ 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 f~&therewith. ~ ~-~__ , Sworn to before me this _ -- ~ /// ~/~ /~ ........................ day of ........... ~~......, 19 ........ ~(t~/ .... ~/~ /~/ Notar, Pub c ~T~~,_. j ~ . · ...... ~~~~ ....... , ~~~~....~..~oun~y ~,gna~ure'of ~pplicant) I~o 52-0344963, Suffolk County, ~ ~ ~ZJ Commission Expires March 30,,1~ ' ~