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Home My WebLink About2233-zNO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~...]..c).~. .............. Date ......................... .l~.tO~e~. ...... '1.~.., 19...~.b¢ THIS CERTIFIES that the building located at .T~.J~.....J~.D.I~,~t~..R.ClS~ ................................ Street Map No.....~ ........... Block No. ~ ............... Lot No ...... ~: ........(J~.~.~.Kl,~g~..~.t...~.~., ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................................... ~.~.~Ob.e~...~.~' 19..6~. pursuant to which Building Permit No ..... dated ............................. 0~.~ .........~J......, 19...~., was issued, and conforms to all of the requirements of the applicable provisions of the Jaw. The occupancy for which this certificate is issued is ........ ............ P~.l.v.a.te .. ~n~...£amil¥....d.~ell lng ..................................................................................... The certificate is issued to ..... ~a...~.~e[O~ql~..~.~l~Ck ............ 0.~,'~,,.~. .............................................. (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ~OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2233 Z Permission is hereby granted to: ...A,.. ~e~,.ea..Dei;male ................................... ............. ~.e~r~or.~t...N~.~. ............................... to ..... ;Bu~l~ ..a~.. $~td.X~;.~.or~..o~.-an.. ~-~,s.t~r~ ..~e3,1~u8 ..................................................... at premises located at ...~1 ....... J~13%i11~..~ ........................ ~ ............................................................. ....................................... .(~r e po~f~ ~,3:.,, ................... pursuant to &ppllcotion d(~ted ................... Oe.t,O]~!~ ....... 2~'. ............ 1963..., and approved by the Building Inspector F' e $ ' ' ' ~"'"'(~" ' X3~" '~ hie /~//~.~ C ~_~, (~' ~--'~-'~' ~{ Building Inspector FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... .~.-,~..~.....~....~......, 19..~..~.. Approved ........................................ , 19...J....Permlt No ............ ~.~.. DisQpproved o/c ............................................................. ~ ................... ............................. ................ ...... .................... ................. ........................... Application No..~]~.~....~.~ ........... APPLICATION FOR SUILDING PERMIT Date ........... 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 o detailed description of layout of property must be drawn on the diagram which is part of this applica- tion. 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 opplica:nt. 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuonce of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicoble Laws, Ordinances or Regulations for the construction of buildings, additions, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable taws, ordinances and regulations. (Signature aT appncant, or name, ~t ar corporabon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................................................... .................................................................................................................... Name of owner of premises ...... ~.,....?....7~...L.z~.?..~./.~...~.. ........ Z~..~...~../rf..C<...~. ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ...................... Street and Number ....-~..'~....~...~...~....~..j~z~.,~. ....... .~..¢ ................. ...~..~.~/'~.../~...~..Q..~.~.. ......................................... Municipality 2. State existing use and occupancy of prem4ses and intended use and occupancy of proposed construction. a. Existing use and occupancy .................. ./..'~...~.....,~...4~/~ ......... b. Intended use and occupancy .............. ///~0 ~ ~ .. 3~ Nature of work (check which applicable): New Building .................... Addition ....~..,. Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ..........~.~.~..¢:L4~...!..¢~....~.. ....................... Fee ..,~-....¢~... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~?./~...4~. .............. Number of dwelling units on each floor .,...(~...j~..~. ..... If garage, number of cars ............................................ 6. If business, commercial or mixed occupa,ncy, specify nature ~:nd extent of each type of use 7. Dimensions of existing structures, if any: Front ....,~..~:~.../. ............ Rear ......'-~....r~..../. ............ Depth ....~...'~...../. .......... Height ............................ Number of Stories ......... ¢2. x~...~. ...... Dh-nensions of same structure with alterations or additions: Front ....... -~,.,~..../. ........... Rear '-~ Depth ...... ..:~.(,,~ ............... Height ................................ Number of Stories ..... ..~...~....,~., .... 8. DimgnsJons of entire new construction Front ...... ~ / ............ . Rear ....... ./....~... .............. Depth ....../'~ / Heig:ht .............................. Number of Stories ....~...../~....~... ............ 9. Size of lot: Front ...... ~.~.~.../.. ....... Rear ...... .x~....~...~...f ........... Depth ...... ./...~....-~..~.../.. ...... 10. Date of Purchase .../]..~./~,].?,.<...,..~.../..~..~...,~. ............... Na,me of Former Owner .,/.~./~..~.,.~'~..~..~....Z.g/.). 11. Zone or use district jn which premises are situated ..... 12. Does proposed construction violate any zoning iow, ordinance or regulation? 13. Na~e of Owner of premises ..,/J.,.~..~.~)...g..¢..,~ ...... Address .~..~.~..-~..4..~.A/..J)...g.~....~....P..Z...... Phone No. Name of Architect .................................................... Address ................................................ Phone No. Name of Contractor ....?~..~..E.~...!;t....~/~.~. ............ Address ..J4~/.~.~.~..({.7..~(../J.~...E..~.~T.~ Phone No. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions f~ property lines. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. STATI" OF NEW YO~I~ , ) COUNTY ~)F ...,~..'.¢./~./=.¢..~.~...,) S.S. ..... .~...:.~...~...~:..~./L.~../~.........~...?."..~...?....~......l~. .......................... being duly sworn, deposes and says that he is the applica (Name of individuai s~ning application) ebove 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 to make and file t~ application; that all statements contained in this application are true to the best of his knowledge and belief; ar that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~ ......... ~.~ day of .................~..., 19...~:~¢ ~ ~, ~ ~ ~ ~ J Notary Public .~~~~.~.~o~ ~ ~ (Signature of applica,nt) J ~ ,~,~.r~.~l~c, ~tate of New York