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Home My WebLink About2050-zFOEM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ......... ~...;~ (~,4, ..... Dote ............................. JU~,,~ .......... , 19...(~, THIS CERTIFIES that the building located at L~.~;,~...~.::~.,....~.,~,2;~.~gP,...~,..~,~7~.,.., Street Cutchogue Map No ........ ~. .......... Block No ............ ** ...... Lot No .......... e~ ........................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................ ~),~vc~Zl,..3.0 .............. , 19.'~.~.. pursuant to which Building Permit No ......... ~...2..050 dated ...................... ~.~b&..,~0. ............ , 19..~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .................................. :I,~.[~J..~:;~.~'~...OI~.. '~'.~:~.~U.L:Z..~'~LL~G.....~...~.,~ ............................. The cerfificate is issued to ..~'~,~.~,~[...~[~,~.. 0~,~,~=. .................................................................... (owner, lessee or tenant) of the aforesaid building. FOE, M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMrSES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2050, Z Dote ............. Art.S1. ...... 30. .................... 19.63... Permission is hereby granted to: Rene Gezt~.on.... ~/. ~ .. ~.~Z&e~... ~ ~t~ ...................... ......... Ja~es~or.t ................................................. to. B~ld..e~t.. addit~oa..o~..~...e~i~tfng...d~e~,.1$ng ........................................................ at premises located at ...~,O.~..~ ................. ~e~o~ie..~r--.~O~)~.¥...~..]~o~t~ ................. .............................................. .C~tcho~ue.~.....N. Y .............................................................................. pursuant to application dated ........................... ~]p~.~. ...... -~O ............ 19~3..., and approved by the Building Inspector Fee $..~..00. ............ FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 .......Permii No .......................... Disapproved o/c ....... .-H~~ .......... _ (Building Inspector) Application No.~,,~.~... f?. ....... APPLICATION FOR BUILDING PERMIT Date~..~¢../. .......................... 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 o detailed description of layout of property must be drown on the diagram which is port of thio 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MAiDE 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, or name, if a corporation) ........ .............................. (Address of. applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name 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 pr,oposed work will be don_~e Map No.: ........... v ............... ~ ........... Lot i~l~ ..................... Street and Number .~~~~~~......~~~ ~'-~// ..... Municipality State existing use and occupancy of premises and intende,,cJ use and occupancy of proposed construction. o Existing use and occupancy ...... ~~ ............................................................................ b. Intended use and occupancy ............ ~: ....................................... %...-; .................................. .~.. ...... ~ ...... 3. Natbre of work (check which applicable): New Building .................... Addition/~. ................ Alteration Repair .................. Remova! .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ....... ~...~. ................................................. Fee .................................................................................. (to be paid on filing this application) 5. If dCvelling, number of dwelling units ................................ Number of dwelling units on each floor If gprage, number of cars ...................................................................................................................................... 6. If b,usiness, commercial or mixed occupancy, specify nature,mhd extent of each type, of u~e ......................... ,4. 7. D~mensions of existing structures, if any: Front ......... Rear. pth ...~....~. Height ............................ Number of Stories .......................................................... / .................. ~,..~. Dimensions of same structure with alteratig~ or additions: Front ........... ~i ........ Rear ...~:. ...... De th He ht ~. ~ Number of Stories 8. Dimensions of entire new construction: .............................. Rear .............................. Depth Height .............................. Number of Stories .............................. 9. SizeJ of lot: Front .............................. Rear .................................. Depth .............................. 10. Date of Purchase .......................................................... Na,m~ of Former Owner ] ], Zone or use district in which premises are situated 12. Does proposed construction vioJ¢_te gQy zooin, fl [aw ord nonce or reaulat, on~ 13. Name of Owner of premises .d~....~.......~ Addres~~¢~-~--~I ..... Phone No ............. ~ te ' ~~ Narpe of Arch ct ......... :""'~x'~.'~.~,~ ........... Address ......~ .............. ,¢..: ...... ~.... Phone No ............ No~e of Contractor~.~. ~ .~....~/.~.. Addre~ ............... Phone PLOT DIAGRTAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions f property lines. Give street and block numbers or description according to deed, and show street names and indi, whether qterior or corner lot. STATE OF NEW Y/DPJ~,¢' ,,.¢ ,, ) _ _ COUNTY fOF .~~..) ............................................... being duly sworn, deposes and says that he is the applic, (Name of individua! signin, g appliCation) above named. He is the ....~~ (Contractor, agent, corporate officer, etc.) of said owher or owners, and is duly authorized to perform or have performed the said work and to make and file atlh~js applicatiod; that all statements contained in this application are true to the best of his knowledge and belief; that' the wbrk will be performed in the manner set forth in the application filed therewith. Sworn to biefore me this "ora,. p"L,i ) . ................................... IX 'y Up C ...,~;~.;~f.~x~r'df~,~,~:.. ~,/eu, pjy ¢~ ~bignature of appdcant)