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Home My WebLink About1864-zF~R,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...... .]E./~d.....W~.b~i~.e.h...De~...Hc~e...Dr. Street Mop No ..... X~,~ .......... Block No ......... ~ ...... Lot No....~1~ ....... ~.t;¢~..~..1~g~.,...~..:.~.,. ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... A~F,,~S~ ....... 2~R..., 19.62__ PUrsuant to which Building Permit No....;~.~..~..~. dated ............................ J[~:1~t; ....... ~ 19..6~., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ..... P~.i~ .. o~e...~:~mil~r...du.e lliz~g ............. ..~ .......................................................................... The certificate is issued to .....;[(~$e.~0h...~,...Z&].e.~L~ ................. O~e~. .......................................... (owner, lessee or tenant) of the aforesa.id building. Approval Nov. 20, 1962 by P, Ma~ko~ski FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING P~RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1864, Z Permission is hereby granted to: ,.,Aa>~cl,.,.,~l~,%~.....A~.C...Jc~se.~h...~;a.Z.e~.t.. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ ~' L/ 19 (~ ................ ...................... :,i .... / c Approved ......................... ?.~ ........... 19 ........ Permit No ............................... Application No..../..,~...~.....~../. ......... Disapproved a/~ ............. ~ ............ APPLICATION FOR BUILDING PERMIT Date ................................ 19 .... :.. 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 location. c. The work co~ered 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 p art for any purpose whatever until o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of o 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/D~ulations. '(;ignature of applicant, or name, if a corporat~ (Address of applicant) State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................... .............................................................................................. Name of owner of prem.ses .......... .~...~....~./: ........ ..~.....~?. .... '~.~]~/.~,~.~.'~. /[ .................................................... 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 ...~..~,,?.-.~;L.2.~:.(~...;~; 'g?;¢.;~ ........~..~.~ ..... :.-.~M..~".~...¢.(¢...~.' ~.~....~.~.~?.¢~.'.¢~; Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of' proposed construction: a. Existing use and occupancy ................~.:.~/.~ .................................................................................... b. Intended use and occupancy ............. ~....~.~.~-~.~.~. .................................................................................... 3. Nature of work (check which applicable): New Building......~..Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... .. ......... ............................................................... 4. Estimated Cost .............. ./¢~5.2,..~......-~.. ................ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ~ ............ h~umber of dwelling units on each floor ............. : .............. .If garage, number of cars: ................. ~ ....... ~, ."'~t~.~,.~........ .......................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ...... ~ ......... Rear ..... ~'..'. .......... Depth .."~...~.' .............. "Height f' e ..... ~ ............ Numb r of Stories ......... q~l~,., ...................................................................................... 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 ....~J~. ............... 9. Size of lot: Front ......../~.O..~ .......Rear ....../.~.c.~.~ ......... Depth .....~/.,~....~. ......... 10. Date of Purchase ........ ~,.....,,~u/~..& ............. Name of Former Owner .......... 11. Zone or use district in which premises are situated ....................................................................................... : ........ 12. Does proposed construction violate a~y zoning law,~ ordinance or regulation? ...... 13. Name of Owner of premises..~.,....2.~.~. ~'~.¢~..~...Address '..'..~.~.~,~.,...~:~.,...~ ....... Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO.' Name of ~'0r~trac~or...~.,u,,¢.~....~/~; ............... Address .....*"~',~..,...~',,..~.. ......Phon~...~..q~./..~. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property iines.'Gi~ve street and block numbers or description according to deed, and show street names and indicate whether interior 'or corner lot. STATE OF NE~¥y/~O~R~,~ Z~/~/ ) S S ~ COUNTY, OF ~~~'....) ' ...~......~ ...~:~..,~...:...~f ............. ; ......... being duly sworn,,.deposes and ~says that he is the applicant " ' (Name Of individua~h'mg~,,~iba~t~ion) ' · , ' "'' , ' , above named. He is the ..........f, crfZ.~.....: .......................................................................... : ....... ........................... (Contractor, agent~ cbrporate officer, etc.) ' , of said owner or owners, and is duly authorized,to p,erform,-or have ,performed the said'work and to make and file this application; that all statements contained in this ap'pl.icQtiph' a~re true to t,b~ best of his knowledge and belief; and that the work will be performed in the manner s~l~rt~h ~i~,.the applicati~filed therewith. ~ Notary Pubhc,~ ...... .~ ..Couf~ty .