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Home My WebLink About2147-zFOR~I NO. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~/~.....P~.~e...~.~e...~d. ..................... Street Nassau Farm~ ~ N Map No ....................... Block No ....................... Lot No. ~'t'"'~$'~'"~"~'t' ....... C'u~ho~t~et'" ~.~. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. ..~..~.g~.~. ...... ..~. ....... , 19..~.~... pursuant to which Building Permit No. dated .............................. AQ~S.~.....,'L~.., 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 ........ ........ ~lv. ate...one...~.~milT~...~.~3..~.i~4', ........................................................................................ The certificate is issued to ....~i'~t},lx:~Th~...,l~zzCt ................ .O~'~e~ ....................................................... (owner, lessee or tencl~t) of the aforesaid building. FOI~M NO. 2 TOWN OF SOUTflOLD 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? 2147 Z Date ....................... Permission is hereby granted to: Midgle~ a...N~.t en.....A/C...A~th~n~ .. Z.~ ~e ................. ......... C~tehog. u~ ................................................ to .. ~u~ld...a~..add it ion...om., an.. e~i.z ~.i.n~.. ~el,l.i.n~ ....................................................... at premises located at ..Lo.~..~. ............ l~'&~,~t'l~,,~;~tB ...................................................................... ...................................... ~ue...T~.e~..l~a ~c~t ........... Cu~h~ue ..................................................... pursuant to application dated ............................ A~I~ust~ ....... ~ ........... .19.6~.., and approved by the Building Inspector Fee $.. ,~ .0.0 ............ I~RM N~. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,ned ...... ........ ,I9 Approved ................. }.[ .................... , ]9 ........ Permit No .............................. Disopproved o/c,}7:Z~.)~.~;:~:::US~~~ .............................. (BuildL~ Inspoctor) APPLICATION FOR BUILDING PERMIT 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 port of this applica- tion. c. The work covered by this application m~y not be commenced before issuonce~of Building Permit. d. Upon epprovol 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 po rt for any purpose whatever until o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS H.EREB¥ MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other ~pplicoble Lows, Ordinances or Regulations {or the construction of buildings additions, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ell applicable lows, ordinances and regulations. (Signature of applicant, or nome, if a, corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder, general contractor.. Name of owner of premises ......... ~ltb-on~r...I.ZZ.O. ............................................................................................................. If applicant is e, corporate, signature of duly authorized officer. (Nome and rifle of corporate officer) ]. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... Street and Number ...~,~.~.,..r~.e..,.~.Q~ ............ ,t. .... 0 ' ....... .~t.0,ho~t~e ...................................................................... Municipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ,..~g~,~l,~,.~. ;~fl~.~ll~*rLQf~ ....................................... ............................ b. intended use and occupancy ]grivate reside~oe ' 3. Nature of work (check which applicable): New Building .................... Addition ....... X ........ Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ...~,cJ.o.Q.,.QQ ........................................ Fee .......... ~.5. o. 0.0. ............................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ....................... If gc}rage, number of cars ....................................................................................................................................... 6. If business, commercial or mixed occupa'ncy, specify nature .and extent of each type of use ............................... 7. Dimensions of existing structures, if any: Front ...... ~.~.?. ............... Rear .............. ~.! ........ Depth ............ 2~..t. ...... Height ....... ~,.8..! ............... Number of Stories ..... ,1, ................................................................................................... Dimensions of same structure with alterations or additions: Front ...... .~...~..~. ................... Rear ....}.~.t. ................ Dep(h~..0..~ ........................... Height ...... ~,.8..! ................... Number of Stories ...... 1 ........................ 8. Dimensions of entire new construction: Front .............................. Rear .............................. Depth ......................... Height .............................. Number of Stories .............................. 9. Size of lot: Front ....... ,~.0,! ................ Rear ........ .~,0,t, .................. Depth ,.,.2~0.! 10. Date of Purchase .......................................................... Name of Former Owner ..0. f~;P.~I...,~D.~,I~'I~.~.:E ................ 11. Zone or use district in which premises are situated ..... ~ ......... ,~O,Q,O. ..................................................................... 12. Does proposed construction violate any zoning ]aw, ordinance or regulation? ............... ~,~ ............................. 13. Nor~e of Owner of pr. emises ..-Z)~9..~.,o.A~'....~.~.0 .......... Address ..~.~ ............. Phone No .............. No ae of .............. ^ddre s ...................... Phone Name of Contractor .................................................. Address ............... ~ ....................... Phone No F~LOT DIAGRAM A 7,/! Locate clearly and distinctly a]i ui dings, whether existing or propose;J, -tsac~, nsions fi property lines. Give street and block numbers or description according to deed, and show street names and indic whether i~terior or corner lot. q, ~0o~ STATE OF: NEW. ~,RJA/ ,/~ ) ¢ c (Name of individual~ning ,applicat~ 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 application; that ali statements contained in this application ore true to the best of his knowledge and belief; that the work will be performed in the manner set forth in the application filed therewith. Sworn to ~efore~me thru ~;'~ i aa[ ........