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Home My WebLink About2166-zFOEM ~0. 4 TOWN OF SOUTHOLD BUILDING DEPART/v~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at Map h~oee~.~lOOd- Block No. Lot No..C, tt.~8~te ............................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................................ A~.*..,;~7...", 19~3... pursuant to which Building Permit No. ~,,~.~...~. dated ................................ AI~tL~$~....~., 19.~.., was issued, and conforms to oil of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ...... ?.~.~.va~;e..ene...~.'~m&.~.~r...d~e~.l~.~ ........................................................................................... The certificate is issued to ..Wm..G~e4~e ................................................................................................ (owner, lessee or ten~,nt) of the aforesaid building. FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2166 Z Date ................... ~.~,$*~ .......... ~.~. .......... 19.6~.. Permission is hereby granted to: Edw A~ ~.~ · ..*.,~/~.....~*/.~- t. fcam..,· ~r~£e ................... .................... ~,~'~t' ......... ............................. at premises located at ..~¢t~th,~,.~-/~D¥ ......................................................................................... ........................................ 'R';'O';W~'"8/~'"'*~"~*~I~"~v~'~'-'"~u~ce~o~t~ .......................... pursuant to application doted ........................ ~.0~I ......... ~ ........... 19..~].., and approved by the Building Inspector Fee $....~,, D.O ........... [ T~O- ~q~u'i]Eir~ Inspector FO]~iV[ NO. 1 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CL.ERK'S OFF~GE SOUTHOLD, ~. Y. ...... ....... ........................................ , ........ No. ........ (euild~n~ Inspector[ APPLICATION FOR BUILDING PERMIT Application No..CY...-! .................. INSTRUCTIONS This application must be completely filled in by typewriter or in ink and submitte~l in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on p remises, relationship to 9djoini6g 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 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 have been granted by the Building Inspector. ~ APPLICATION 1S HEREBY MADE to the Building Department for the issuance of a Building Pek'mit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable ~aws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolifion, x~]s herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. · (Signature of appli(zant, or name, if a, corporation) Mattit~tck '~ (Address of applicanti~,, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician plumber or builder. .............................. .................................................................................. : ............. ............... ...................... Name of owner of premises ~,~.~.~,m Grefe If applicant is a corporate, signature of duly authorized officer, (Name and title of corporate officer) ood !,~ 1. Location of land on which proposed work will be done, Map No: BeaehW 'i! LQ3 No: .................... Street and Number ~t R.O.N,, S/.~ New Suffolk Ave, Cutehogue 1 '" ~ ..................................................................................... Municipality I'~i ........... ?~ ....................... 2. State existing use and occupancy of premises and intended use and occupancy of propbsed construction: o. Existing use and occupancy ....... .~.~..~l,~..~g ................................................................ 7: ......... :~'": ....................... sam~ with addn & alt,,~rati n b. Intended use and occupancy ....................... ~.~ ......... ¥...~ .................. 3. Nature of work (check which applicable): New Building .................. Addition ...ilf,,~ ....... Alteration ...~. .... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Esti~nated Cost .......... b~.~.OO0...p/M ........................... Fee ..~ .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ...... On~ ................ Number of dwelling units on each floor ......................... If garage, number 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 ...........~.~, ................ Rear ........ ,~.i~ ............... Depth ......~. ............. Height ............................ Number of Stories...~ ....................... 9. Size of lot: Front ................................ Rear ............................ Depth ........................................ 10. Date of Purchase ........................................................ Name of Former Owner .~ .................................................. ] 1, Zone or use district in which premises are situated .......... II~.U..(J[~ ................................................................ 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ........ ~ ..................................... 13. Name of Owner of p?emises ..... .~,~.....~.~Address ............................................ Phone No ................. Name of Architect ...................................................... Address ............................................ Phone No ................. Name of Contractor ...~..~b~.¢}~ ...........................Address .....~,~ ................. Phone No ................. PLOT DIAG~.M Docate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr, property lines. Give street and block numbers or description according to deed, and show street names and indic~ whether in~erior or corner lot. 1 STATE O~ NEW YORK, ) COUNTY OF ~'~:o~ ........... ) S.S. ...................... ~.~..~.¢~ .............................................. being duly sworn, deposes and says that he is the applic~ (Name of individual signing application) above named. He is the .......... CO~¢~O~ ......................................................................................... ? ........................ ~ (Contractor, agent, corporate officer, etc.) , of said o~ner or owners and is duly authorized~t~ ~rform or have performed the said work and to m~ke and this applidation; that all statements ,¢qntain~'sjbe[~a~?cation are true to the best of his knowledge and bel ,:~and that the work will be performe~ ~es~t~'f~,~fth in the appliD~tion filed therewith. ~5worn to before me this ~o...~ss~0n Exp*ros ~arch SO~ J~ ~/ ( -- / ' ......... ..... % ...... ..... 7' . ............ .............. ........... ........................... Notary Public, .~zA.~...~z..~.&*~d&~.~. ~gunty/, (S,gnature of applica~