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Home My WebLink About1909-zFOI~M NO. 4 TOWlq 0F SOOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY T/~IISiC£RTIFJES that the building located at ~C:L'g'~t~ .'CCl, o~f ~l~t~let~t;, Ave, . ' ~eenpore, ' confor[ns substantially to the Application for Building Permit heretofore filed in this office dated /d~ted .............. O~O~.Ig...~. .................... , 19...~., was issued, and conforms to aH of the requirements / o~: the applicable provisions of the law. The occupancy for which this certificate is issued is ........ '[he certificate is issued to Ca (owner, lessee or tenamt) of the aforesaid building. FORM NO. 2 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 1909' Z Permission is hereby gronted to: L~'~n~-. &-..¢m,~o.J....~t',atl~t. t-1. ......................... ........... ~tr~enpo~t. .............................................. to "~ve'"In"an"e'xTst'i~"bul'~'d~g ...................................................................................... at premises located at .W/~..~ffI~.,g...i~....~l~l;.j..~ ................................................................. ............................................ Gl, ee~pol,~t...~,.¥.~ ................................................................................ pursuant to application dated ................................ 0C1:0~1' ...... 9.....19~.., and approved by the Building Inspector Fee $t(~ ~) ............ TOWH OF SOUTHOLD BUILDING I~EPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, H. Y. Approved ........................................ , 19 ........ Permit' No. Disapproved O/C~.....~-~ ........................ ~ii~i~ ............ Application No......~,....~...~.. ........... APPLICATION FOR ~UILDING PERMIT Dote ............ .¥?,.. ~.' ......... '.~ .................. , 19..,~..~T 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 drown 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MA.DE 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 applicant, ar name, if a. corporation) ....-.(..~. ............ ~ ....... :: ......... ~.~..~....,,,.::..z.,. ............................... (Address of ajSplicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, piumber or builder. ......................... ~s.~,~.~..~ ...................................................................................................................................................... Name of owner of premises ~.?..f. ...... ~.~.?~ ................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... Street and Number .............................................................................. ./~;~;i~.i~.~i¥...~, ............................................. State existing use and occupancy of premises 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) ..../~.q.~..~;....~:~'/~'~' t~ 4. Estimated Cost JOO ~ ........ ........................ .................. .........,. Fee ........... , ........ . ..................... .. ....... .......................... ........ .., (to be paid on filing this application) 5. If dwelling, number of dwelling units ................................ Number af dwelling units on each floor ............................ If garage, number of cars ...... t(.......~.'?..,,z~. ................ ' ' ' 6. If business, commercial or mixed occupo'ncy, 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 ................................ Rear ................................ Depth ................................ Height ................................ Number of Stories ................................ 8. Dimensions of entire new construction: Front .............................. Rear .............................. Depth .............................. Hei'ght .............................. Number of Stories .............................. 9. Size of lot: Front ........... ,~...O..~? ........... Rear ......... t:'..O,..0. ................ Depth ....~..~.?... ............... 10. Date of Purchase ..... ..~.?..c.....,/......(..?.~../. ......................... Nome of Former Owner ....~...~../..4(...... ,~,,~/..~,~ ......................... 1 1. Zone or use district in which premises are situated. ",4'" t~,~'1'~ / 12. Does proposed construction violate any zoning ]aw, ordinance or regu at on? ...... ..~...?, ................................................. 13. Name of Owner of prem ses Address ..?r.:..Z.....?.~..¢...5../. .......................... Phone No.~..~....~'.;./.~i,.~ Nome of Architect .................................................... Address ................................................ Phone No ................... Name of Contractor .................................................. Address ................................................ Phone No .................. PLOT DIAGRAM Locate clearly and distinctly ail buildings, whether existing or proposed, a'nd 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. STATE OF NEW~YOP~If, COU NTY~.)~~, '~ _ .......... ~~ ....... .../. '~.~..z~...,-~ ......... being duly sworn, deposes and says that he is the applicant (Name of individual signing_applicaf~n)~ 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 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 befa~ me this Notary Public ..~..~-s~ou~y""; .................... ~'i~ature of applic~,~¥ .............................