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Home My WebLink About2123-zFOI/~I NO. 4 TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ~/.8.....~.~,.[¢e~...~, ................................. Street Map No..":]r~ .............. Block No .......~ ........... Lot No...~T~.....]~(~..~tt~'.~.O.~; .............................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................................... ~T~'~'~t' ...... '~-~'3 ....... , 19.(~.. pursuant to which Building Permit No ...... ~?-3. Z dated .............................. ~U.~'y.'"'~'~ ...... , 19..t~,.~., was issued, and conforms to all of the requirements of the eppJicabJe provisions of the Jaw.. The occupancy for which this certificate is issued is ........ · ,p~,v,~,e .,ene,,~e~.~&.y.. ~t,,~e .t.~:~t~ ............................................................................................... The certificate is issued to ..~j~.~,,~e.~..~)~ .......................... OVt~'le:~ .......................................... (owner, lessee or tenant) of the aforesaid building. 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? 2123' Z Date .......................... 0'U~'""~ ............. 19'63" Permission is hereby granted to: · Tosepb De er~:o sic1"'-' ~/¢-----~he~.~S ..-~O~g~tt ................. ............ · ~,t~t~l.~,~k .............................................. to ~utld...an..addit lor~..o~..~u., exlst, lr~.. ~wellir'~ ......................................................... at premises located at .*l~*/~..-..~:a~:kSon"'~;' .................................... ', ................................................. ........................................... ~ew...S~f.o l~, ...~L ~, ............................................................................. pursuant to application dated .......................... '~tt'].~/"'"'~* .................. 19~.,.., and approved by the 13uilding Inspector f ~ ' ~Budding 'trfsp~o¥' ~ TOWN OF SOUTHOLD BUILDING DEPART/~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ ~ ~ , 19 ........ Approved ........................................ , 19 ........ Permit No ................................. Disapproved o/c ................... .................. .......................................... (Building ~f~sp~ctor) 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 drown 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 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 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 nome, if o corporation) Mattituek (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder· · .0. ................................................................................. Name of owner of premises ........ (~,,1,'l.~..,'~.~L.~o;~.~n ........................................................................................................... If applicant is o corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No' ......~..4~... .......................... Lot No: .......... ~... Street and Number .......... S/&....,I. aeks.on.....8.tss ........ New..El~fo.lk .................................................................. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~.~.~J~Ag .............................................. i ....................................................... b. Intended use and occupancy If W/ addition 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration Rep.,air .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost .........~,..'~6~'~00"~/M ..................... Fee be paid on filing this application) 5. If c~welling, number of dwelling units "'"OI'~ .................. Number al" dwelling units on each floor If garage, number of cars 6. If business, com~rcial or mixed occupancy, ~pecif~,~atureand extent~of each type of use ............ 7. Dimensions of existing structures, if any: Front .......... 39 ........... Rear ........ 39 ............. Depth ...... ~.~ He(g~t ............................ Number of. Stor~es .......~ Dimensions of same structure with alterations or additions' Front ................................ Rear ................. De~th ............................ 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. Da(e of Purchase ........................................................ Name of Former Owner 11. Zone or use district in which premises are situated .......... ~...~$.2~ 12. Do~s proposed construction violate any zoning law, ordinance or regulation? 13. Name of Owner of premises '"'~'""~O~ ....... Address ........ ~..~ ......... Phone No. Name of Architect ...... ~.....~ee~o~ ................... Address ...... ~.¢¢$¢~O~. ................ Phone No. Name of Contractor .................. ~ ................................Address ............. ~1 ............................. Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimension property I)nes. Give street and block numbers or description according to deed, and show street names and whether i~terior or corner lot. STATE OF NEW YORK, ) COUNTY O~ .............. ) S.S. .................... ~.~...~O~ ....................................... being duly sworn, deposes and says that he is the appiic, (Name of individual signing application) abow~ na~ed. He is the ............ ~.~O~ .................. (Contractor, agent, corporate o~ficer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this appliSation; that all statements contained in this application are true to the best of his knowledge and bel and that the work will be performed in the manner set forth in the application filed therewith. Sworn tobefore methis ~ ~ (~-- t Notary Public, . ........................................................... County (Signbture of applicant)