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Home My WebLink About2178-zFOiR~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ....... ~..2212 ....... Date ........................... ~b~.ua~/'...2....., 19-.65. THIS CERTIFIES thor the building located at ..... ~¢;~eze..~t~e.~...~.oJ~.o~.~ .............. Street Map No.....~...'.::.?.:: ....... Block No ............ ..-..-..?.?.. Lot No ............. .?.?.~.,.-..-...-..-. ....................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... EiJ.e.p.l;.~a.1;te~...5 .............. , 19..6~.. pursuant to which Building Permit No: doted ................ ~.¢I~.t~ffl~J~f~..5. ............. , 19.6.~..., 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 ........ ...................................... o~e...~14r.. J:~.~ .~,ene~ ....................................................... ' .................... The certificate is issued to ......... ,~.~..~.~Z"],~ ................................................................................ (owner, lessee or tenont) of the aforesaid building. Building Inspec[or FOI~M NO. 2 TOWN 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? 2178 Z Date ................ ~;epte~be~.......~. ............ ~ 9.63.. Permission is hereby granted to: ]~:c--~ · .. · .l:q~eh. .................................................. · '~3-O~ ....... .3;Lst-..--A. ve .................................. ..... :.. A~s~.o~-~&~... ~ .~. ~. ~...}~.~.¥.~ ........................... to t~J.'tcl'"n'ew "on'e" ~amJ~ ~y" d~e']~ t:~ng ..................................................................................... of premises located at ~./~;.....~'~e~s,..B~e .................................................................................... ............................................. .Southo&d-r....~,,;g ................................................................................ pursuant to application dated ................................. 'Se'~)~ ........ ~" .......... 19..(~., and approved by the Building Inspector Fee $. ~.0~.00. .......... Building Inspector 1' FOI~I~ NO. I ': -~xammea ...................................... , t9 ........ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .................... ,. ................... , 19 ........ Permit No ................................. Disapproved a/c ~? .......... ~..~.....~~"~'~ ............................................................ ........................... · · ................................(gu iding inspector) '-'-' '-'iu'-'f '''''!''''--'-': ................................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the gui]ding 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 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 an~, 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.oture of applicant, Or name, if a corporation) ............. ............... !.., .............................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, eibctrician, plumber or builder. ......................... ~t ~ .~.~.. ..i.: ................. / Name of owner of premises ....... JJ[~CJ~,..]~:~T.~,~h ................................................................. i.i...\i .......................................... If applicant is a corporate, signature of duly authorized officer, i ' (Nome and title of corporate officer) " 1. Location of land on which proposed work will be done. Mop No: ~ '~ '~ Lot No: Street and Number ...... .~/,..q.....Tll~l~e~s...~,,~r~t ................... ~.O~/~h(llf~ ..... ' , , .............................. Municipality ,: , 2. Stere existing use and occupancy of premises and intended use and occupancy 6f,,proposed ~?nstruction: a. Existing use and occupancy ................................................................................... !.~ .... } .......... b. Intended use and occupancy ......... .o..n.,~...r..~...~.l. JL...d.~e..!l..~.n.g ........................ :..,~, ......... 3. Nature of work (check which applicable): New Building ....... 3f,IQQ~. Addition .................. Alteration Rep~3ir .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost .............. 1.~10~..]~/.~ ..................... Fee ..... ~,.0. (to be paid on filing this application) 5. [f dwelling, number of dwelling units ....... O~e ................ Number of dwelling units on each floor If garage, number of cars .............................. OI'~,~ ...... 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.....~4~ ....................... Rear ......... .~ .............. Depth ......... ~8 .......... Height ............................ Number of Stories...,O~ ....................... 9. Size of lot: Front ....... 100. ................. Rear ...3.00. ................ Depth .......... 2,00. ...................... 10. Date of Purchase ............. 1.96~ .................................. Name of Former Owner 11. Zone or use district in which premises are situated ........ 12. Does proposed construction violate any zoning law, ordinance or regulation? ............... 13. Name of Owner of premises .~.~...:t[~.;~,.~.~ ............ Address~.~.O.~...~3.&~'~....A2.tO~';~one No. Nome of Architect ...................................................... Address ............................................ Phone No. Name of Contractor~'De..~l~].t¢,~ ............................. Address ........... ~]l~.tt.t;]3Ol~. .............. Phone No. PLOT DIAGRA,M Locate 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 indic whether interior or corner lot. STATE OF NEW YORK, COUNTY OF ..... ~'~].~ ...... ) S.S. ...................... .~O~.¢l~..]:[e~'.~ ........................................ being duly sworn, deposes and says that he is the applio (Name of individual signing application) above named. He is the ..... ~.i~.e.~3.'I;...O~...D.!4~r'Z~IZ' ............... (Contractor, agent, corporate officer, ~tc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all stotements,g~aic?e~_fl this application are true to the best of his I~nowledge and bel and [hat the work will be perfar~edP¢~c;ffs~'tcr~erf0~t forth in the application filed therewith. Sworn to before me th s No. 52-0344963, Suffolk County .¢' , ' Commms~on Expires March 30, l~j , / , .~. dav of Sep. te.,m,,b, er , 19 63 // ~ /t,~/Z, , ~ / ' ....................... ........ : ........ .,. ...... ........ :...i Notary P~iblic, .~.~':~.d?~.~.~.~...~.......~.~.~.~.~:~¥.~L..~./~:.~.. ~' T' (S,gna~ru're ~appl,ca~nt) S-9 SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH ~t~ Bldg. Permit Noo TO WHOM IT MAY at CONCERN: The sewage disposal facilities f~pr a structure located (Give deed locatioZn) have been inspected by this department and found to be satisfactory. Distriot ~h~gineer .... District Engineer