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Home My WebLink About1622-ZNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...JJ..]J~J(~ ........... Date ..................... eT~lt~i~'""J.9 ........ , 19.68. THIS CERTIFIES that the building located at ...~j'8.....J~,O~l..Jj&/tjlt~l..RO~d. .......... Street gassau ?oint Club Bop Map No ....................... Block No ....................... Lot No .... ~/~..&..~ ....... ell.~0j~12e.li.....~.~,' conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... J~O~JJ~F ....... 6 ............ 19..~.. pursuant to which Building Permit No...~,~.. dated ....................... D. QO.~F.....6..., 19.6'!., 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 .......... .......... ~vate..oa®..,~a~J34r..due3,1~,~ .................................................................................... This certificate is issued to ..... ~O~d..M&;J.~lJr~ ............~Jll~ ........................................................ (owner, lessee or tenant) of the oforesaid building. Du' a'ng tnsp cto 1 FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS I~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 1622, Z Date .............. ])~b~:F......6 ................. 19.(~,.. Permission is hereby granted to: George..~,e~ s.-.A/C.. Ho~at, d.. ~le..t~ke ................. to. · ~t ld...an. - ~ d.~.t.i~r~ ..o~.. ~n.. ~x.i. st ~ng.. ~l~e t.t i~g ....................................................... at premises located at "/~ot"~'"~(~+"&"~5' ......... tia~sau..Point ................................................ ............................................. l~ead~a.te r,.. [load 't'"" C. u. tehog~e ............................................... pursuant to application dated .......................... ]]~ ....... 6 ..................... 1~...., and approved by the Building Inspector Fee $.5. i~JO .............. uilding Inspe~ FOEM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. omined ............ Approved ........... ~.:....~?.., 19..~./..Permit No. '~/~'~ ~ Disapproved a/c ........................................................................................... ( B u,~fi~g InspectOr) APPLICATION FOR BUILDING PERMIT App,catian No ..... ../..~.~..~: ....... 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 tot 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 port of this location. 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 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. The applicant agrees to comply with oil applicable lows, ordinances and regulations. ............. .......... ...................................... (SignatureJ~f applicant, or name, if a corporation) (Address of applicant) ............................ State whether applicant is owner, le.~see, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate, officer) 1. Location of land on which proposed work will be do,ne. Mop ............... Lot Z ~....~.~.~ Street and Number ................ ~..~.'~:).. ....... ~ ....... ~.., .~...~.~.......~... Municipality State existing use and occupancy of premises and ,;71,.d use and occupancy of proposed construction: a. E×isting use and occuponcy ............... ................................................................................. b. Intended use and occupancy ................. ~..=.)~~ ................................................................................. 3. Nature of work (check which applicable): New Building .................... ddition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. £stimated Cost ........ .~....O...O. ..................................... Fee .....~,~5 .................................................................................. (to be poid on filing this opplicotion) 5. If dwelling, number of dwellin~ units .......................... Mumber of dwellin~ units on eoch floor .................................. If ~oro~e, number o{ cots ..................................................................................................................... 6. ff business, commerciol or mixed occuppncy, specify noture ond extent of eoch type o{ u*e ................................ 7. Dimensions o{ ~xistin0 structuros, if ony: Front ...........~ ............ Root ............ ~ ........... Depth ....... ~. ................... Hoi0ht .......... !g.} .......... ~umbor o* Stories ............... (. ....................................... ..................................................... ~imonsions of s~me structuro with olterations or odditions: Front ............... ~ ............ Root ........ ~Q ................... D~pth ............. .~..~'. ....... ,oi~ht .......... Z ................... Numbor o* Storio* ...... ~ ......................... 8. Dimensions o{ entire now construction: Front ....... (7.~.~.~ ........ Roor ..... ~2~.~ ...........Depth ...(.~.~.~.~ ............. Height ...... .~.....{.L ...... ~umber o{ Stories ............. ~ .................. 9. Size of lot: Front ....... ~ ................ Rear ......... ~g ............... Depth ....~.~ .................. 10. Date of Pu~hase ............ /.~. ................................... Name of Former ~ner ...~C~.~5 11. Zone or use d str ct n wh ch prem ses are s tuated ................. ~.~.~ ......... ~/. .................................... 12. Does proposed construct on voate any zonng aw, ordnance or regu aton? ~ ................ ' ~ / c, ' r ~ ........... ~'Z ............. ~ ~f Ar~hit~t .................................................... Addr~ .......................................... P~ ~0 ..................... N~m~ ~f Contractor ...... ~ ...... ........... ....Address ..-~r~...,-...~...~.t~.~.... Phone NO. ~ ~" PLOT DIAG~M L~ate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from pr~erty li~s. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. I 1_ 15'' (Signature of applicant) JUDITH T. BOKEN Sworn to before me this I~ata~/ Public, State of New York /No. 52-0344963, Suffolk County ............... of ........ STATE OF NEW/'~'p,I~_K,~/~, ) S S COUNTY OF~.~.~....) ' ' ........... (.-.e..o. lc.cl.e ......... ///.~..e..~..5 ................................................ being duly sworn, deposes and says that he is the applicant (N-6'me of individual signing application) above named. He is the .............................................. {~'R!.~...~..C.~..c...~.o...(. .............................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, ond is duly authorized to perform or have performed the said work ond to make and file' this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith.