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Home My WebLink About2195-zFOIEVl NO. 4 TOWN O1: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY MS/D, (~oose C~'eek, ohannel conforms substantially to the Application for Building Permit heretofore filed Jn this office doted dated ................. '........./....0.~.~.....2 ........... , 1 9...~4~., was issued, and conforms to oil of the requirements of the applicab? provisions of the Iow. The occupancy for which this certificate is issued is ........ (owner, lessee or tena,nt) of the aforesaid building., H.D. Approval At~ ~,, 18, k 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? 2195, Z Permission is hereby granted to: ....... ~r.eenD~ .................................................. to ....... ~.~...~.~...~...~z..~.$~ ............................................................................... at premises located at ..~,O,N,...SZ8...G~osm..C=~ek~..~f~..W~S...~,~..~F...~..~a~.. pursuant to application dated ................ ~e~ ....... ~ .............. 19.~,., and approved by the Building Inspector Building Inspector / 0 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ................ , 19.. £~ Approved ........... (J....: ./. ........ ...~......, 19 ........ Permit No ................................. Disapproved a/c ....... '.; ...................... ~.t....:.....' ......... ' ........................................ ~ ,;~x !.~ ,, ' , . ............................................... Application No. ~ I c~ ~ (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................... ~, e ~b ~.~ii~e~.....2 .~. ...... , t 9..6.~ .......... 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 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 g~anted 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. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ...................................... O~'~e~. ................................................................................................................................................ Name of owner of premises ..~l'~..~',,...l~a~.~'~It ............................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. L.oc~tion of land on which proposed work will be done. M~p No: ....~2.....~..[~ ...... Lot No: ...... ~ ....... Street and Number .~/B..R~.W.~...~f~...F~...~...~s~:~..~a~...(~..~.se..Cr~e~)..~u¢~d .... Municipality 2. State existing use and occupancy oF premises and intended use and occupancy of proposed construction: a. [xistlng use and occupancy ........ ~&~.~..~][~ ......................................................................................... ' . , b. Intended use and occupancy ........... O~e...~,~$&~...d~e~[~g ........................................................................ 3. Nature of work (check which applicable)' New Building ..... 2r~lr,~... Addition .................. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ...... ~,.~¥000..~./.~[ ............................. Fee ......... 10 (to be paid on filing this application) 5. If dwelling, number of dwelling units .............................. Number of dwelhng 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 ........................................................................................................ Di?ensions of same structure with alterations or additions: Front ................................ Rear Depth ............................ Height ................................ Number of Stories ........................................ '~,, 8. Dirnenslons of entire new construction: Front ...... .lz~,=.~...(.&.~O.} Rear ...... Height ............................ Number of Stories ......Olo, e .................... 9. Size of lot: Front .-..'1~'O .................... Rear ........... '~'0('} .......... Depth ....... 10. Date of Purchase ................. 391~..~ ............................. Name of Former Owner '"f~e..&..'¥~'~.l~ ................. 11. Zone or use district in which premises are situated ........ ~tA~t..~..:~,~ 12. Do~s proposed construction violate any zoning law, ordinance or regulation? ............. n~ 13. No'ne of Owner of premisesM~..t~..Ifla~,,.~.e~ ............ Address ...~e~l~...~O~.~ ................... Phone No. Name of Architect .......... l:l&l~...~o:l~ ................... Address ...~,i.~'~Zthe~ ................... Phone No. Name of Contractor .H~.'t......~.O~~ ........................... Address ...l~.~V~ea~ ................... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions f~ property fines. Give street and block numbers or description according to deed, and show street names and whether in}erior or corner lot. STATE OF NEW YORK, ) COUNTY OF ~%~"~'O.]~ ........... ) S.S. ........................... blol%te...~/~.~'er~. ........................................ being duly sworn, deposes and says that he is the applicc (N,ame of individual signing application) above named. He is the .......... O'~e~ ............................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to oerform or have performed the said work and to make and f this applicotion; that all statemer~ s;.o~l~dT~TJ ~q~lf~is,applicotion are true to the best of his knowledge and bell. and that the work will be perform~rf~'~[~,~o~?orth in the application filed therew th. Sworn to b~fore me this ................ ~.~... da~.~%/of ....:..._7.,~,e~.~e~,l~ol~..~......' 19.6;~../~.~./..~?,~. Notary Pubhc, .~.~.f.C~........~........~.~ ...... c ~ .~.t~.~'~,~.c~'~, (S.gnature of apphcant) / · ¢4. / / ~CTML o~.//' ' "~-.. ~ / "-. "" ', e... ,,.,'.. '<'%' ~"' / / 3 ? L ,41v' SPC. l i .E, A3T' ZLL'VATION' I[ ~[ $£C. 30uYff E££VATION 7 // .ZL_ Z_Z ZZr~LZ : #O_RTH£RZ? £LEYAT/O/V6- 3£CZlOJf6 2 ~ 6, ~, 22o- 8~c. I '1 I E/ -~?ATIOI7 - 6E C. .,tc£ 8IDI'Ar 6 £ 'tD.,q, : 80VTi'-IO.g-D , ~r'. Y. 'k $£TTION5 T:?t£J]L KXT, t~055- $£tlC_MA 7'1 C ~Z UTtDtJ~q 5£'C ~5£ C 77 0.Ar g / ~.I.,~G.~RM~- ZI6 &CALK II Q,o.