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Home My WebLink About1907-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN Ct~ERK'S OFFICE SOUTHO/D, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ~'I~Z.]..~...:D;C:;~.V.~...~%~,f,r.;~.~.tAg..~. ........... Street Map No..../f.*....... ........ Block N~ .~.~ .................. Lot No ..... ..w.~..*. .......................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... .Q.q.~..~.~'...~ ......... , 19...~..~... pursuant to which Building Permit No .......... .~.....1.907 dated ......................... .O.~.~...o..b..e...r.....5. ....... , 19...~.2.., 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~,IVAT~ O~tE FAMILY D~LLI~G The certificate is issued to ...~b..n,...~..¢A..doma, owner (owner, lessee or tenant) of the aforesaid building. Building Inspector FOl~,l NO. ~ 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.° 1907, Z Date .................... (~t, ob~' ....... ~ ........... 19-62. Permission is hereby granted to: .~..~J. s~he~......~zC.....,Tol~ ..l~Ad~ ........ ........... ~4a.1~1; .t.~ue~ ............................................... to · ~u&.i ~.. -a~ · - a~d.t-t &.or~ .. o~..eh.. ~.~.~.~i. ng.. ~e .t.1.t n~ ........................................................ at premises located at .~/,~.....l~,~..1.~.ne...L~r,e ................................................................................... ...................................................... J~t~.~-~,~e~ .................................................................................... pursuant to application dated ........................... Oot,~b~ ....... .~ .......... 19(~.2..., and approved by the Building Inspector Fee $-.-~.O0- ............ Building Inspector FORM NO. 1 TOWN OF SO~TNOL~ ~[LD~ ~PA~T~NT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned ....... ,,9 ........ Approved ........................................ , 19 ........ Permit' No ............................ Disapproved a/c .............~ ................ .................... ..................... (Building Inspector) ( Application No. / ? 0 '7 · ' 'LIC^TION FOR ,ERM T Date ...................... , 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 applica.nt. 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 o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other ~:pplicable 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 afl applicable laws, ordinances and regulations. ......... ~ (Address of applica~ 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) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... Street and Number ..........~'~~' '"~"'~' 'M Pelfy'''~]~i~','''' 'i'"' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. o. Existing use ond occuponcy ............................................................................... b. Intended use and occuponcy ..... ....... ................... ~'~ . ........................................................ 3. Nature of work (check which applicable): New Building .................... Addition ......z~...... ...... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost .............. .~..~.c~..O...~ ............................... 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: Front .......... ~...~.. ............ Rear ....... ..~..~ .............. Depth ......... ~..~. ............ Height ............................ Number of Stories ..... ../.. ....................................................................................................... Dimensions of same structure with alterations or additions: Front ......... ...o~..~ ................ Rear ....... ...~....?. ............... Depth .............. .~...~.../. ...... Height ................................ Number of Stories ......../. ....................... 8. Dimensions of entire new construction: Front .............................. Rear .............................. Depth .............................. Height .............................. NUmber of Stories .............................. 9. Size of lot: Front ...... ./.,,vq~...q.../. ........... Rear ..... ./,x.~..~....''. ................ Depth ....... ../.~../.. ......... 10. Date of Purchase .......................................................... Na,me of ?ormer/,(/Owner ........................................................ or use district in which prem ises are situated ....... ~'~...~ ................................................................. 11. Zone 12. Does proposed construction via.ate any zon ng law, ordnance or regu atio,~? ............................................................. 13. Name of Owner ofpremises/'-~f~ ~;z'/'~ Address ~.~'.~ Name of Architect ....i-....~/'.,'~ii;~iiiiZi~' ........ ;.;;i; ...iiii Address i~i.'.~.'~.....i..ii, .... P.LOT DIAGRAM Locc]te clearly and distinctly ail buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description .a:ccording to deed, and show street names and indicate whether interior or corner lot. STATI: OF NE.W )~OR.K., . z, ) SS above named He s 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 statements contained in this 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 filed therewith. Sworn to~me this ~ Notary Public ~~~~t~ (Signatu~of applicant) ..................... I'm 52.0344963, ~uffo[k County Col~lmJss~m~ Expires March 30,