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Home My WebLink About2039-zFOI~M NO. 4 TOWN OF SOUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No.. Z17(~8 .............. Date .................... ~o.v, embe~......~. ......... , THIS CERTIFIES that the building located at .~/D...]~lee.t,.~.~..]~ec~k..~.o~c~ .................. Street Map No ...... .~.~..e..~.~..... Block No .......... ~ ..... Lot No. ~ ......... ~.13,¢.~hOg~.s.....~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office doted ........................................ Ap~'.il....22...., 19..(~3.. pursuant to which Building Permit No ....... dated .......................... ~.~L~.....22 ........, 19..~., 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 ........ ..~r.~.~.P,.~.e....o.~.e...~.e,~*.lY....~.~.elling ............................................................................................... The certificate is issued to ...~*],w~,le. 6L..C}~.a.~,hw.o~l ............................. 0.%~. .................................. (owner, lessee or tenant) of the aforesaid building. H.D. Approval Nov. ~, 1963 By R. Villa ...... fi4.~ ............. ~ ................... Building Inspector FOI~M NO. ~ 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? 2039 Z Permission is hereby granted to: , ...................................... z,~. ......................... ~ Z'A ..... ..................... pursuant to application dated ....................... /~t...'.~.../?~.. ...... ~.......'~TTi... ....... 19..i(...~, and approved by the Building Inspector SUFFOLK COUNTY DEPARTME~T OF HEALTH o te Building Permit No. TO WHOM IT MAY CONCEPJ~: The sewage disposal facilities for a str~cture located at w/S Ppqu~ ~pq~e~ 30,O's/o North Cro,s,~,Road ~ Cp$cho~ue (Give deed location) have been inspected by this Department and found to be satisfactory. District En~ine~ District Engineer ~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... .(r..~...%?.~:~~.~...~.~. , 19..~.~..?.Permit No .... ..~..~....~..~.~... Approved (Building Inspector) "~ Application No .......... ~.~....~/~..... APPLICATION FOR BUILDING PERMIT Date ~"~ '~ [~-' ~)- 2~- ![ .~... ................... j ................................. , 19 .. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot ptan 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 thi~ applica- tion. c. The work covered by this application m~y not be commenced before issuance of Building Permit. d. Upon epproval of this application, the Building Inspector will issue a Building Permit to the epplica,nt. Such permit shall be kept on the premises available for inspection throughout the progress of thb 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 MA;DE 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, 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 applicont) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises .......... ~ ....... .Q~. ............................................................................. 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 ....~.'....~..~!..~..,.c~..~ ....... ..~..~.~..~.,.'w..'~.. ..... ' - ~ ~:~ ................................ Municipality 2. State existing use and occupancy of presses and intended use and occupancy of proposed construction. o. Existing use and occupancy ............................................................................................................................... ..~.. b. Intended use and occupancy ~ ~'-V.~.....~%~ff:ZZ~ ......................................... 3. Nature of work (check which applicable): New Building ......."/~...?:'.. ..... Addition .................. Alteration .................. Repair .................. Removal ........... Demolition .................. Other Work (Describe) .................. 4. Est mated Cost ~. ~.) ~ ................................... ~" Fee ..... /~.O ............................................................ (to be paid on filinq 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 occupa,ncy, 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 ................................ ..... / o ~d~- G 8. D~mens~ons of entire new construction: Front .... ..~.....~.... Rear /-/X/- ¢ o ..../ ~ .......................................... Depth .............................. Height .............................. Number of Stories ..... ./.....~ ............. 9. Size of lot: Front ...... Z.~...~.. .............. Rear ....../.....6T~... ................. Depth .../..~-~O.. .............. 10. Date of Purchase .......................................................... Ne.me of Former Owner .}......~..~ .......................... 11. Zone or use district in which premises are situated ......... .~ ....................................................................................... 12. Does proposed construction viol.ate an~, zo~iz~a~lo~w, ordinance or regu arian;) /(/~ 13. Name of Owner of premises ......~..~...~.~....~f~. ..... Address ................................................ Phone No ................... Name of Architect .................................. .[ .;~_ /~ / ~. .............. Address ................................................ Phone No ................... Name of Contractor ....~...~..q~~.c~..' ............... Address ................................................ Phone No .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~.~'O,J~, PK' ~ ) ~ ~, COUNT'~3x~ .~.......'~ ...) -~,-~. .............. ~....~L~ ....................... being duly sworn deposes and says that he is the applicant individual signing lication) ~me of'i~iN 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 to make and fife this application; that all statements contained in this application are true to the best of his knowledge a.nd belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ............... ~.~a~ of ............... ~ ~ ......... , 19.~ , ~,~ ~, oto. ............................................. 'y ~/~.,~. ~,~~,0f/~0~ry { / ~igna*ure or applicant)