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Home My WebLink About2176-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located a~/.~...~..$..~.~:~.~...O:~z...~*..~.....G..z'.~.e.~...O..Z,].~.. .... Street Fleet field ,~ 12 Map No. Block No. Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated September 4 1 pursuant to which Building Permit No. dated Se]ptember 5 19...6...3.., was issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ PI~IVATE OITE~ FA~IIL¥ DWELLING The certificate is issued to 8heldo~ H, & Margaret Brooks, (owner, lessee or tene,nt) of the aforesaid building. Building Inspector FOI~i~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2176' Z Dote .......... Septem:be~...-..5 ................... I~3 .... Permission is hereby gronted to: 8he.l.d~n.. l)~.~ok~ .................................................. ........ .Htd~e~ton.-.Hc~d ...................................... ................ G~e~po.r.t ........................................... to ... ~tt:t. ld... a.~.. m~t d,l. t.i. om..on.. ~'1...ex.~, s.t~mt~.. ~1~ llil~ ...................................................... ot premises located at .~o~..6~.....~.eee6.~.~.e.~d ................................................................................. ..................................... ~/~B.. t~{etetten...Rel, t....-$reen~.~ ......................................... : .............. pursuant to application dated ...................... ~e.~lll~e.lt.....J,g..; ......... 19~..., and opproved by the Building Inspector Fee $..5.,.00. ............ Building Inspector FOEM NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................... k..~. ............... , 19..l~.....Permit No .............................. Disapproved o/~~~ (Bui Iding )4%pector) Date ................................ , 19 ................ 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 p remises, relationship to adjoining 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 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. (Sign.ature of applicant, or name, if a corpor, ation) __~., /(\~dd~___o~p~pl~t) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. prem ses .~--~ ~ ..'.~... ~4:~.~,~,~~ Name of owner of . .._.._,~/,.~ .................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of lond on wh ch proposed wor~w be done Mop No' Lot No' Street and Number ........... Municipa ity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~.~,~.'~-.~...~....... '.............r....~,, ................ b. Intended use and occupancy .............. .~~~.....:.~...~.....~~ 3. Nature of work (check which applicable): New Building .................. Addition ...../~........ ..... Alteration Rep,air .................... Ren~val .................... Demolition ........... Other Work (Describe) ........................ (to be paid on filing this application) 5. If dwelling, number of dwelling units .............................. 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 Front.....~ 7. DinJensions of existing structures, if any: ............ Rear ........ ........ Depth ...~./ Height ............................ Number of Stories .../.....~ Dirriensions .~f sarAezstructure with alterations or additions: Fro~/t ............ ~ .......... Rear ......... ~ ......... Depth .......~../../.~.. Height ................................ Number of Stories ................ ~ ....................... 8. Dimensions of entire new construc' n: on .......... ~', ............................................. p ........... Height .... Numb r of Stories L ..... 10. uaT~ of Purchase ........... ./.~__~....~.'. ............................ Name of F~orj 1 1. Zorie or use district in which premises are situated. 12. Does proposed construction.vi~lc~t.e,~an~/_zonin,~, -,~ or 13. Name of Owner of premises ./k~f~~..). Phone No. Name of Architect ...................................................... Address ............................................ Phone No. Na~e of Contcoctor ..................................... Address .................................~hone No. PLOT DIAGRA,M Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fn property lines. Give street and block numbers or description according to deed, and show street names and whether interior or corner lot. STATE OF NEV~ ~(ORI~,//. ~ ,~ ) S S COUNTY OF .~r)" ' ' , . ~ii'/~ ')~ being duly sworn, deposes and says that he is the "i~;i '~~;'.d..u..a-ii:igning application) , [ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to Derform or have performed the said work and to make and this application; that all statements contai[led ii~JlJ4J~l~sTalz[~J<i~otion are zrue to the best of his knowledge and and that the w~rk will be performed~in the'~'~}0~r~t~he~lication filed therewith. Sworn to bef~e~me this ~ ComJmss~o~ Exp~r'es March 30, ~