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Home My WebLink About2165-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....Z,..1.7.~.6 .......... Date ................. No.v:embe~......19 .......... , 19-63. THIS CERTIFIES that the building located atI J:l~'.~..j...I~.$.O.e~t~.~...W/~...~...~l~...Vt~...R~jStreet Map No...~ .......... Block No ......... ~ ....... :Lot No. :le:r~c~:t ......... {~o~tho~ .............................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... A~IBt~,....~.-.-.-, 19...~..~. pursuant to which Building Permit No ...... dated ............................. &%lg.l~.~;.....~(~.., 19....i~ 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 ........ ............. l~.t.V~t e.. ~ e...~, a.m.~.ty.,..dwe ~..~. i ~g ..................................... : .............................................. The certificate is issued to ....Jetm..l~...P~.ee ............ ; ......... ~tae~' ...... : ....... :~ .............................. [owner, ~essee or tenat~ of the aforesaid building. Building Inspector FOI~I~ NO. 2 TOWhi OF SOUTFIOLD BUILDJhiG DEPARTMENT TOWhi CLERK'S OFFICE SOUTHOLD, hi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPI~ETION ,OF THE WORK AUTHORIZED) N? 2165, Z Permission is hereby granted to: Jo:hn..,~,,...P.~le~ ....................................... : ......... ' at.premises Ioceted at ~/~.....~/.~.~.-.R~),~..e£f..~d/~.....~er~..~LY~-e~...~o~.~:-~/-..Geose ~e, .......................................................... ~o~thetd. .................................................................................. pursuant to application dated ............................. .~g~.~¢ .......p_~ ........ 19~.,~...., and approved by the Building Inspector Fee $..~, .................. FOR~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................ :'L.i.../.' .............. , 1 9 ........ Permit No..~:~./. 4. Disapproved O/C ........... ~>"~ .................... ~L'~'~ .................... .......................... ................... /'::~/' ........ :.'"'"'"";..".:A ......................................... ' (Building In~)ector) APPLICATION FOR BUILDING PERMIT 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 premisbs ~r ibq?ic streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is p6rt 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 tl~e ~appl cqnt. 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. i/ ' APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building rm~t pursuant to the Building Zone Ordinance of :the Town of Southold, Suffolk County, New York, and other apphcable Laws,¢,Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as hereto described. The applicant agrees to con?fy with all applicable laws, ordinances and regulations. (Signature of applicant, or name, 1¥ a '~orpora~'en) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder.. ........................ O.wner..-. builder. ...... :;i ......... :. ................ Name of owner of premises . . ~.O~1 H~,...P~J~I,O~ ................................................. ~ .............................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporal' 1. Location of land on which proposed work will be done. Mop No: .............................. C ........ (... Lot No:'. ................... Municipolit~y 2. State existing use and occupancy of premises and intended use and occupancy 9f proposed constructiO¼: a. Existing use and occupancy ..... O~.~O.].[;t. llg ....................................................................... y~l .................... \ ............. b. Intended use and occuponc~ ......... ?. ............ 3. NatUre of work.(check which applicable): New Building .................. Addition ..X~1~.~. ...... Alteration Replair.............,..~ .... Removal .... .......... .. .... Demolition .................... Other Work (Describe) ..... ~&~'~:O ....... 4. Estimated Cost' .....~.~0..~/.~ ...................................... Fee . ! (to be paid on filing this application) 5. If dwelling, 'number of dwelling units .............................. Number of dwelling units on each floor If garage, nu~nber of cars 6. If business, commercial or mixed occupancy, specify nature.and 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 ......... .'1.~ .................. Rear ....'~'8 ................... Dbpth ......... ~ ............. Height .,~X....~...!l, ....... Number of Stories .................................. 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Date of Purchase ........................................................ Name of Former Owner 1 1. Zone or use district in which premises are situated .......... .~.~.~ ........ d~.~ 12. Does proposed construction violate .any zoning law, ordinance or regulation? ........ ~J~ ....... 13. Name of Owner of premises ...... ~.OJ~...j~.~ .......... Address ........ ~O~1.~'~' ................ i. Phone No. Name of Architect ...................................................... Address .......................................... ~. P~°ne No. Name of Contractor ..................... t~ ............. U. .............. Address ................ ~ ....................... /.. Phc~0e No. PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all se,~-ba~zk ~limensions fn property lines. Give. street and block numbers or description according to deed, and show street ~mes and whether interior or corner lot. STATE OF NEW YORK, ) COUNTY OF .... J~.l~'~.O]..~ ....... ) S.S. ................. ......~.O~'t,.~.....J~.~.~..... ...................... ~ ................ being duly sworn, deposes and"say~ that he ~i.~ the appli, !Name o~ individual signing application) abow~ named. He is the ......... .~.~i~ ..........l~t~L~..~ : (Contractor, agent, corporate officer~, etc.) ' of said o~;ner or owners and is duly authorized to perform or have performed the said wo~k a¼d to m'ake and this ~pplication; that all statemeots contai~j~r~ in tills application are true to the best of his knowledge and bel and that the work w be performed in. tb~/itr~/1.ff?rB~forth n the/qppl,ie, at on f ed thereby t~ ' Sworn to before me th,s ~",- ............. :..~..~..... day of ............... '1~'[11~'~':"":'I'~'~'~'~'f'~ ~~ Notory Public, ~,':/.~(,../.-./~/......'~.'....~.¢%c:M'~..C,,,~,%Z