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Home My WebLink About2141-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...... ~1. ~. ~,~ ........... Date ............................. 0~.~ .~.......~.~., 1 c)...6.,~.. THIS CERTIFIES that the building located at ..E~...~.~.~,.~.QQ~..~ ........................... Street Map No..~ .......... Block No....~ ......... Lot No..~, ....... ~.~.~..~.~.....~.*.~,e .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................ ~.l~gt~ .......... ~.. ....... , 19...~.,~. pursuant to which Building Permit No ...... .~...~..~.~.], dated ...................... ~.l~..~..S.~. ....... ~.. ......... , 19.~.~...., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ............ .................................................................................... The certificate is issued to .,,~,Z'~.~'~..~..~].e~. ............................................ (~/D. eZ*. ......................... (owner, lessee or tenant) of the aforesaid building. ~,Do Approval Oet. l?, 196S by R. Villa .................. ...... Building Inspector ( FORM NO. 2 TOWI~ 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? Permission is hereby granted to: ....... ~%.~t%u¢.k ................................................... pursuant to application deted ................................ ,~11~-I1~.~,.--.-~ ........... 19..6.~.., and approved by the Building Inspector Fee $' ~(},t'O0 .......... ....... ~.~ .................... Building Inspector ',},[ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............ Application No. ~ L~[ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a, This application must be completely filled in by typewriter or in ink and submitted in duplicete 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 d~toiled description of layout of property must be drewn on the diagram which is port of this application. c. The work covered by this application may not be commenced before issuance of Building P~rmit. d. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No budding 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 fl,~ HEREBY MADE to the Building Deportment for the issuance of o Building Permit' pursuant to the Building Zone OrdinUnce of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the c0.nstruction of buildings, additions or alterations, or for removal or demolition, os'herein described. The applicant agrees 'to (~omply with oil applicable Iow% ordinances and regulations. ~' Edw. Ab~tz · (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. Contra.~tor , , ' , If applicant is a corporate, s, igr~efure of duly authorized officer. (Name and title(.,' Of corporate officer) 1. Location of land or~ ~k~ich proposed work will be done. Mqp No: ......... ~....~ ..........! ...... '... Lot No~ .............. ~ . Municipality 2. State existing use abd 'occupancy of premises and of/proposed construction: a. Existing use and occupancy 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated ~ost ..7.~..~,J~t~l~O ..................................... Fee ......... ]..0. ./ (to be paid on filing this application) 5. If dwelling, number of dwelling units ....O1'~ ................... Number of dwelling units on each floor If garage, number of cars 6. If business, commercial or mixed occupancy, specify natureand 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 ........ l~l, ............... Depl:,h ..... ~,),~8 ......... Height ...... ~ ..................... Number of Stories.....~ltll ..................... i. 9. Size of lot: Front ......... ~-00 ................ Rear ........ .'!.00 ............ Depth ............ TI..~.0 ..................... 10. Date o(f Purchase .............. ~,96.] ................................ Name of Former Owner ......... I 1. Zone or uae district in which premises are situated.....ItA~ ............ 12. Does prOpose~d construction violate any zoning law, ordinance or regulation? ....... Jla ......... i ....................... 13. Name of, Owner of premises ..... ~,...~'.~-e~ ............... Address ............................................ Ph&ne No. Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor ..... llt,,...A~.~,~ ........................... Address ....... ,[~.~t~..tll~ ............... Phone No. PLOT DIAGRAM Locate clearly '(]nd distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block numbers or description according to deed, and show street nantes and whether interior or corner lot. STATE OF NEW YORK . ] ~. ,., .'~ .......................... Ed~,~.A~..': ........... ~ ............................... being duly sworn, deposes and say~ tha~ ~e is the applica (Name of individual signing application) .' /~ ~ / ~, (Contractor agent corporate officer, et~,~ ~' of said owner or owners,/and is du¥..authorJzed to perform or have performed the said wokk an'd tm make and t this application; that all statement~ 6ontained in tKis application are true to the best of his k~wledge and beli and that the work will be performeA,~n ~R~T~n~E~et forth in the application filed therewith. ., Sworn to before me th'~ ~o 5P,o'~44963 Ru ~u n //~ ~ / ' ~ ~