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Home My WebLink About2187-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING D~PARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .......... ~. 17~.~ Dote ~{ovet~fb¢:~:;c 4 ~.3., THiS CERTIFIES that the building located at z Map NoG* Z~ ~[Hc~h~k No. ~* Lot No. 94 conforms substantially to the Application for Building Permit heretofore filed in this office doted ................................. ~.¢¢~.¢;~t~X.,,~...., 19....~ pursuant to which Building Permit No...~.~.~.Z.. doted ....................... ~e.pte¢~'~r...,t,~-..., 19...65., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ '[he certificote is issued to ........... ~. ............................. . .............. .... (owner, lessee or tenant) of the aforesaid building, Building Inspecto'rr '~ ' ~01~'~ ~0, ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 187 Z Date ........................ ~e.l~t~}t~:~.....~.. 19..~.~. Permission is hereby granted to: l~z'$,~ '"'~e!~ez~'" "~/C~' .~ug~ne..t~o~ ............. ............. · Br~¥'"Av-e ............................................... ........................ ~ag.~, ~.uek, ................................... to ....B~.~i.~. · ~n...ad~ .~.~i~.. on...a~...e.~f~t .~ng...~ ~.~d ~n~&~..h~ &d ~ g ........................ at premises located at -...I,O.t,...~.~...&..P.t,...9.~.~......~.~.~u.t;h~L..~b ............................................ ....................................... ~/.~....~t~,...A.~ ....... I~u~.e~L ................................................................. pursuant to application dated ......................... ~.e~'"'"]:~r ................... 19~..., and approved by the Building Inspector Fee $"~,'GO ............ · ~'~' Bui?ding -Inspector i TOWN OF SOUTHOLD ~UILDING DEPARTMENT ~OWN CLERK'S OFFICE SOUTHO/D, N. Y. Examined ~.. ..................... , 19 ........ Approved ........................................ , 19 ........ Permit No. Disapproved a/c ./~ '~y* t~ .................. ~.. (Buildin~l Inspector) Appiic6tion No. c~ J ~L I APPLICATION FOR BUILDING PERMIT Date ................... ~. f~&q .~.e,~b.~l?..... ~,.(J....., 19,6.3 .......... INSTRUCTIONS a This application must be completely filled in by typewriter or ih 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 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 bf this application, the Building Inspector will issue a Building Permit to the <~pplicant. 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 qf the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the constr~uction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to co'Tnply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owraf'~ lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................. C.ot%~ ac ~:.o ............................................................................................................................. Nome of owner of premises **~b'ql~***]~O.~ ........................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title b~ corporate officer) 1 Location of land on ~hi~h proposed work will be done. Map No: Lot No: Municipality 2. State existing us~ and occupancy of premises and intended use and occupancy oF proposed construction: Dwe. lllng a. Existing use g.,nd occupancy .................. .............. .................. : ........................................................... b, Intended use 8, nd occupancy ......... .'~/~d.C,~.~.&.O~ ...................... 3. Nacure of work (check which applicable): New Building .................. Addition ....][,](;]J~.... Alteration ............. Repgir .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ............................................................ Fee ..~-.~,.00 .................................................................... (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 ............................ 7. Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth .......................... Height ..: ......................... Number of Stories ......................................................................................................... Dim. ensions of same structure with alterations or additions: Front ................................Rear ............................ DepJ'h ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ................................ Rear ............................ Depth ........................ Height ............................ Number of Stories .................................. 9. Size of lot: Front ......... ~ ...................... Rear ............................ Depth ........................................ 10. Date of Purchase ........................................................ Name of Former Owner .................................................... 11. Zone or use district in which premises are situated ....... .l,l~ll...d,~,.~J ................................................................... 12. Doe~ proposed construction violate any zoning law, ordinance or regulation? ............... tl~ .............................. 13. Name of Owner Of premises ...;~'~,e..~.OX ............ Address ........ ~&~,l~.'l ...................... Phone No ................. Name of Architect ....~ ................................................. Address ............................................ Phone No ................. Name of Contractor ...~..~¢~..~$~ ................. Address .......... ~¢~ ............ Phone No ................. PLOT DIAG~.M L_ocat9 clearly and dJstinctiy all buildings, whether ex[sting or proposed, and indicate all set-back dimensJo~s fr~ 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 NEV~Z YORK, ) ~ ~ COUNTY OF .J~.l,l~..ft.O~[: .......... ) ~'b' ............................. be,ng (Name of individual signing application) duly sworn, deposes and says that he is the applicc above named. He is the ..i ...................... J%~.etlt..~:~..~o~tr. ao.to~. ............................................................................. ! (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 this oppiicbtion; thai' all stbtements contained in this application are true to the best of his kffowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to/,,J/~-~b~'°'r~ me this ............. ............................. , Notary pu*,ic, .............................