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Home My WebLink About2199-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z...1.9/,.-~. ............. Date ......................... .O0.~Ob.e~.....l~....., 19...~..... THIS CERTIFIES that the building located at ....~/.~.....J'~i~.~l,..~..~.~,~J~..~.lt..~ ...... Street Map No ....... ~ ......... Block No ......~.g~..".'.' .......... Lot No....X~.. ...... ..8..O..~.t...h..o...1..d..l....~.~.:..lr..: ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... g.c.t,. ...... ], ............. , 19...~,.~. pursuant to which Building Permit No....~...1.?.?...~ dated .................................... .O.~.~.....~....., ] 9....~.,.~, 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 ........ ..... ............................................................................................ The certificate is issued to ...... C}.~o~'.~...~.a.f~ ................. ~ ..................................................... (owner, lessee or tenam) of the aforesaid building. Building Inspecto~ FORM 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.o 2199 Z Date .............. .O~.~O~e~.....-~. ................... 19..6.3.. Permission is hereby granted to: John .~u~.~s ...h/~.....O~.. ~r. ~.t h. ............................ ..... .~t e~o~.n~ .................................................... to 't e "~ '~ ' ' ~:~ ~'iot~ · ' o'~-' ~n' · 'e~'~'J:~tit~g' '-d~e ]:t~n~ ......................................................... at premises located at '"~'~¢:~'~'Z'~"'~'~e"'&"~'t~"~O~t~ ................................. t .............................. ................................................ P~o,~t h~ .~1 ............................................................................................. pursuant to application dated ............................. (~-'1~1~....-]; ........... 19..(~.., and approved by the Building Inspector Fee $.~,,.OCt ............. ~din~ Ins TOWN O.F SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N..Y. Approved ........................................ , 19 ........ Permit No .......... ' Disapproved a/c ............... ~ ............................... Cm - ................................ Application No....~.... !...?.....~ .......... APPLICATION FOR BUILDING PERMIT Date .......... i ............................... , 19 ....... INSTRUCTIONS o. 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 13uilding Inspector will issue o 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 part 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. and regulations. The applicant agrees to comply with all applicable laws, ordinance.......~..,.~ (~'~ ure of applico t, or name, if a corporation) ~ (Address of applicant) State whether applicant is,owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. .............................................................................................................................................. Name of owner of premises ....... ~.~....~.'....~.....~.....~.. ........ ..~...r ........ ~Z~..~ ............................................................. if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) ,~, /~2( ~., ~/~',/ Street and Number 6~/~/~,-/~ .................................. .~,.'.~,, C%~/~'//'~q,. ........................................ Z/~Jb ~/~ ~Z ...~.../~ ./...~,.'. ..................................................../J Municipality State existing use and occupancy of premises and i nten, ded use and occupancy of proposed construction: ..... nc /04, a ~x st ng use ann occupa y .... t... . ............ . b ntended use and occupancy ...~...[..~.....~...~/~....~,.'....~..:'""'..'f-~----" -- ) ............................................. .......... '"' '"'"'"'""'"'"' Nature of work (check which applicable): New Building .................. Addition ~ Alteration Repair .................... Removal,(.. .................. Demolition .................. ~ Other Work (Describe) Estimated Cost .................... ~. ~.~...~...~.! :....~. ................... Fee .............. ~: ....... .~ .......................................................... (to be paid on filing this application) If dwelling, number of dwelling units .............................. Number of dwelling units on each floor ........................ If garage, number of cars ......... ~ ........................................................................................... If business, commercial or mixed occupancy, specify nature,and extent of each type of use ............................ 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 Dimensions of entire new construction: Front ............?...O.. ............. Rear '~ ~) ' Depth ........................ Height~.~.~/~.:....../,.?.../. ........ Number of Stories .................................. Size of lot: Front ........ /.~..~.. .............. Rear ......... .'~/../. ............. Depth .......... .~....~.Z .................. Date of Purchase ..........7/..../../..~.....'.~. ..................... Name of Former Owner .,.~...~...~....... _~...C..'~...~.....~....J~... ...... Zone or use district in which premises are situated ............................................................................................. Doeb proposed construction violate any zoning law, or~linance or regulation? ..... ,.,~,....~. .................................... k._ Name of Owner of prem.ses .~...~../..~.....~.~l...J~.¢Phone No.~'..¢..,..]..~.~[.~..? NameName of°f ArchiteCtcontractor L~....O.~.~.~.~''''~ ........................ .~.:.Z~.~6/.~./~: ............. Address .~...~.//~Address ........................................... ~/, '~'/6~0~,?,,~.. PhonePh°ne No ~,~LNo. r PLOT DIAGRAM ,, f, arl~/ and distir~ctly all buildings, whether existing or proposed, and icate all set-backdimensions r4~m Give street and block numbers or description according to deed, street names and indic ' or corner lot. 10. 13. L.ocat~ cl~ property lines. whether interio % % STATE OF NEW "~OR)(,/ ,¢ ) - COUNTY, OF,~..) 5.S. ........... ~....D....~..~....~...,...~./~...~.<...~....~... ,~. ............................ being duly sworn, deposes :ys that he is the applica (Name of individual signing,,~Bplication) above named. He is the ..................~..~..(~.~.....'~...~...~....~....~....~....~...: .................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or 'have performed the said work and ta make and f this application; that all statements contained in tk;i~,c~z)lJcation are true to the best of his knowledge and beli~ and that the work will be performed in the ma~r~ ~'~/.¢'~I~BJ)r~[~he, qoplication filed therewith. _Sworn to.b~efore me this __ ~/~..~..../~.: ...... day of ..../~.~.., 19..:.~..~ '~k~'q:- ///~~ ' ,,,~-~ ~-,_j ~'./'~ ~_' ~ ......."'.'"':.(("' .................................. [.~..:...{.:.% ......................................... Notary Public ..... ~rgr-ry,,¢¢,~ ~f?...~,~un~/_ , ~/ ~'"~S"ff;(Signature of applicant)