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Home My WebLink About2054-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTN~,EblT TOWN CLERK'S OFFICE SOUTHOLD, lq. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...~'.~,'~.~. ~.~.e.....~..9,.~.e. ....................................... Street Village Ma~or Map No ....................... Block No ........ Z~If.~ ......... Lot No. ~ .~..~..~$~..'J}..~..q.~.. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. ~/JS~,,L,,,,3 ............... , 19~... pursuant to which Building Permit No..~...2..0....~...... dated ........................... ~/.....3..'. ............ , 19.~3.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .......... · r.~,v~te...e~e....f:amt.ly..~wel~ ..................................................................... : ................ The certificate is issued to .~,, ~.~L~..~..J.~. ~ .~.$~.e. !~..q..~..~...e,~. ............ ,,01j~..e~.8 ................. (owner, lessee or tenant) of the aforesaid building. H.D. approval August '63 By FOI~M 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? 2054' Z Permission is hereby granted to: ......... · ~.~l.~k ................................................. to..Bu:t~d...t~e~.. ~ne ..£~-IF ..d.~e.lt.i~ng .................................................................................... at premises located at .. ']~t....'2'~ ......... Fi.l. ta~e..Mam~. ............................. .................................... .................................................. ~l.~ag~ .-.lin. me ~ .......... ~l.t,zek. ............................................... pursuant to application dated ....................... ~ ......... 3 ..................... 19.~.., and approved by the Building Inspector Fee $'"t0~ .............. Building InspectorI . FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............... ..~.. ........ , 19 . Approved ........................................ , 19 ........ Permit No .............................. Application No...~.?..E..~.. ...... (Building Inspector) 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 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 buitding 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 H.EREBY 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 o1: 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 cr corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... C.o.~:~.r.~,.c.~;.om ............................................................................................................................. Name of owner of premises .,,,.W~l..,~.&x.~.¢,2..,]'I,.~c.,~7.ar~,¢,, .G. or.e.].2.az, ............................................................................... 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.: .....Y.%~,~!-.~.g.~....~.~Q?-.* ..... Lot No.: ....~.~ .............. Street and Number ....~.f..~.%,**.~...~,a.~e .......... Ivf~.~;:c.J~. e,'c ...................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occ. upancy of proposed construction. a. Existing use and occupancy ....lZa.¢tS.t3.~;...].o.t, .................................................................................................... b. Intended use and occupancy .... 0.~ ~..¢~.1.~]_~.. c~¢.e..l .] .-L~'3.F¢~ .............................. 3. Nature of work (check which applicable): New Building .......]f2~.. ....... Addition .................. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost .........],~.~..~.00 ....................................... Fee ...... ~.0. ..... (to be paid on filing this application) 5. If d~/elling, number of dwelling units ................................ Number of dwelling units on each floor If ggrage, number of cars ............................................ 6. If b~siness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dim,~nsions 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. Dimbnsions of entire new construction: Front ~....~6 ...................... Rear ............ .~ ............. Depth ...~),1.,*.~ ............ Height .............................. Number of Stories ......... .Q~-e .............. 9. Size:of lot: Front ......... ],.'LO .............. Rear ...~_3,0 ........................ Depth .....~.~.?.~. ............ 10. Date of Purchase ................... }.c).~ ............................. Name of Former Owner 11. Zone or use district in which premises ore situated ..... ~!~!!.....]).J~.~ .................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. ~O 13. Nom, e of Owner of premises ...~)F~2¢.~.~:~...~...C~.O,],~'.. Address ............. ~a.[-,l;.J_.~z~: .............. Phone No. Nature of Architect .................................................... Address ................................................ Phone No. Na~e of Contractor ..... '.'~.~/...,~.b.~.J;.~ ....................... Address .......... J~a.J.,.t..]..~t~.~ ................ Phone No. PLOT DIAGRAM Locate dearly 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 indk whether interior or corner lot. STATF OF iNEW~ YORK, ) COUNTY 0F ..~.1~t~.'D.~L~ ......... ) S.S. ................. ~ .............. ~.~..A});~.'~ .......................................... being duly sworn, deposes and says that he is the applica (~ame of individual signing application) above named. He is the ................ ~.~)~.~z~,~¢~ ............................................................................................................... ~Con~ractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sai~ work and to make and file t~ application; that all statements contained Jn this application are true to the best of his knowledge and belief; ar that the work will be performed in the manner set forth in the application ~herewith. Sworn to b~fore me this ~,~ __ .................. :..~., / . / --~~~da~°f ......... ~&~ .......................... ,19~.~.~,~~,~ /~__