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Home My WebLink About1870-zFOP~M NO. 4 TOWN OF $OUTHOED BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .,FTLee,tw~o~...~z~ad ................................... Street Map No...Y~ ...............Block No..:X3[ ................ Lot No..Y,~ ........... .Czl~g, lze,~,.,~^~ ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................. ~ti.,~ll-~.t; .......... 2.9. ....... , 19~2... pursuant to which Building Permit No..,~..Q. dated ............................ ~IZ~IL~I~;.....3.Q., 19..~,!.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ....... P~. ~,~ ~.~.~ ...or~e...~'.~,.~,y... ~.~.~ ~& ....................................................................................... The certificate is issued to ..[.,...~.,...~,~-~G~lefc .............. Ow~e;~ ....................................................... (owner, lessee or tenant) of the aforesaid building. FOI~M NO. ~ 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) N.o 1870' Z Dote .................... ll~l~l~t '"'~0 ............. 19~1~"' Permission is hereby granted to: goF¥~n..lh,~.....i~...8~..l~,... at premises located at .l~.~,~l~..]~l~ .......................................................................................... ................................... ~eet,~.-.llee~.t. ....g~l~,~le ...................................................................... pursuant to application dated ......................... ~l~r~,~,....~. .............. 11~....., and approved by the Building Inspector Fee $..~00 ............ Building Inspectot TOWN OF SOUTHOLD I~UILDiNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , ~9 ........ Permit No ................................. (Buildin~ yspector) Application No. //Oc~ ) 0 APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely titled in by typewriter or in ink and submitted in duplicate to the BuiMing Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving.o 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 o 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 hove 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 applicant, or name, if o corporation) .... (/M¢Sress' of applicant) ................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .......... : ....................................................................... , If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land orl which proposed work will be done. Mop_No: ............................................ Lot No: .................... Street and Number ...~¢~...~..~ ...~...¢~....~... .............. ~..~~.~...~..C..~.-.. ..................................................... Municipali~¢' , State existing use and occupancy of premises o~M~ intended use and occupancy of proposed construction: a Ex st ng use and occupancy ~...~ b ntended use and occupancy (¢¢~" ~'¢ -~..~.~.~.. ......... 3. Nature of work (check which applicable): New Building .................. Addition ~ Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..................... ../~.~...~.. ..................... 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 type of use ................................ 7. Dimensions of existing structures, if any: Fron ............ ~i .......... 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 ........................................................ Nome of Former Owner ........................................................ ] 1. Zone or use district in which premises ore situated ................. x¢.~...'72.. ....................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~. ....................................... 13. Name of Ownerof premises ..,~'.r,,~:/,.~~ ...... A d d r e s s ~J~. ~'...~/~.r~,. · .'.~.~t~ -~ OJ~' .~.~.~..?-..~...~f>'~ Name of , Architect .................................................... Address .......................................... Phone No ..................... Name of Contractor ~ ............ Addre ~.. Phone .-..~.c..'/.~.~..7... PLOT DIAGRA,M 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 interior or corner lot. STATE OF NEW. Y,,OI~ /_ ) __ COUNTY OF ..~..) ~'~' (? '.Cf., ........ ~ ................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) /~ 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 and file this application; that all sto~O~ts,~toined in this application are true to the best of his knowledge and belief; and that the work will~f~r~d~e~ manner set forth in the application filed therewith Swam to before, me t~ml~s~;~4~.~63, Suffolk Co~/~'~.j ~ ~ '~ / / ............. .................. Notary Pubiic,~..~-~?~~ (Signature of applicant)