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Home My WebLink About2509-zFO~ NO. 4: TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. -.~...2~?,~t- .......... Date ..................... A~I,Z ...... .~ ............. , 19..~.. THIS CERTIFIES that the building located at ..J~.~...~.0,~,,...Jj//~..~tg~J ...................... Street Map No..,~K::l[ ............. Block No ..... ~ ......... Lot No..:~1~ ....... ~t.e,],t ..... ~J,,Z~ ....................... conforms substanhally to the Apphcation for Budding Permit heretofore filed m this office dated ................................... J~,])~.~ ..... ~., 19 .~. pursuant to which Building Permit No ...... ~.~(~. dated .............................. ,~.~.~.er...~19....~, was ~ssued, and conforms to all of the requirements of the applicable prows~ons of the law The occupancy for which th~s certificate ~s issued ~s ........ ...~t1'a~.. one..f~,m~ ~:~...d~zelling ........................................................................................ The cert.ficate is issued to .... ~."~..~O~ .................... ~'~el?. .................................................... (owner, lessee or tenant) of the aforesaid building H.D.Approval April 1, 196~ by ~, Vl~la .... ................... 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? 2509 z Fee $..]kt~..l~tO .......... / Permission is hereby granted to: / Col'-~ l~at~wo~Z..A/¢ .. ~ ..~eu.~ ............ ;;~// ............ ~ta~olp.~ ............................................. to . .~(]L..~.. OJMI~., ~J~l~ 3.~.. ~1.¥e"1.~, · .~l~ .................................................................................... at premises located at .... LO~W.~...Okt;~..,]~/~.....~9~O~[4a..~]lr...]j~l.~[ .......................................... ............................................. Z~mte3., ..... ~I.L ................................................................................... pursuant to application dated ............................ ~e]p-ta~l:~.....~ .... 19~I~ .... and approved by the Building Inspector SCND SUFFOLK COb~TY DEPARTMENT OF HEALTH Date ~ ~)~, ' ! 19~5,, Bldg. Permit No. TO WHOM IT MAY OONCERN: i\1 / 5 The sewage disposal facilities for a structure located at (Give de~d lOcation) - have been i~ct~ ~ this De~ent and fou~ to be satisfacto~. D~trict E~ineer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ............................................................................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a Th,s application must be completely filled ~n bv typewriter or ~n mk and submitted ~n duphcate to the Build~n~ Inspector. b., Plot plan showing location of lot and of buildings on premises, relahonship to adloming premises or public street or areas, and gwmg a deta,Ied description of layout of property must be drawn on the diagram which ~s part of this location c. The work covered by this application may not be commenced before ,ssuance of Budding Permit d Upon approval of th~s apphcat~on, the Budding Inspector w,ll issue a Building Permit to the apphcant Sucl permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used ~n whole or in part for any purpose whatever until a Certificate of Occuponc, shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of o Budding Permit pursuant to th- Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or a Iterations, or for removal or demohtion, as here~n described The applicant agrees to comply with all applicable laws, ord ~nances and regulations (S~gnature of apphcant, or name, ~f a corporation) .................................... fi' (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ...................................................... .................................................................................. Name of owner of premises ............. ~(.~..~...~ ......................................................................................... If applicant is a corporate, s~gnoture of duly authorized officer. (Name and t~tle of corporate officer) Location of land on which proposed work will be done Mop No ........................................... Lot No' . .................. Street and Number ~-~?z,~-~..'~..~.~.~.~...../~xt~4'L~.~.'~/(.;..~.~...~,.,.z~..,....~..~. ...................................... ~' Municipality ~ State existing use and occupancy of premises and intended use and occupancy of proposed construchon. a Existing use and occupancy ......................................................................................................... __ b Intended and 3. Nature of work (check which applicable) New Building .... ~ .......Addition .............. Alteration .................. Repa,r .................... Re~)ova~l ................... Demolition .................. /~th~er Work (Describe) ................. 4 Estimated Cost ..... 'i..~.~Y..r.¢';¢..~. ....................... Fee ............. ~.'....~. ..................... (to be paid on fihng this apphcabon) 5 If dwelhng, number of dwelling umts ........ ./. ........ Number of dwelhng umts 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 D~mensions of existing structures, ~f any Front ...................... Rear .................. Depth ..................... Height ................... Number of Stones .......................................................... Dimensions of some structure with alterot,ons or oddit,ons. Front ................. Rear ................ Depth ........................... Height .................. Number of Stories ............... 8 D~mens~ons of entire new construction Front ..... ~ .............. Rear J~ / .. Depth ...... ~ ........ Height ..... ~.~..~. .......... Number of Stories ../~ . . 9 S~ze of lot Front ...... /~/. Rear /~.[. ~..~ . . Depth .~4 x ............ 10 Date of Purchase ..................................................... Name of Former Owner .~~~ .... 11 Zone or use d~str,ct ,n wh,ch prem,ses are s,tuated ...... ~.~...~~ ..... ~.. ....... 12 Does proposed construct on v~ate any zomng law, ord nonce or regulation~ ...... ~ ........ 13 Name of Owner of prem,ses~~ ....... Address~.~ ~. ........ Phone NO .............. Name of Architect ..... ~ ...... , ....................... Address ...~ .., ..................... Phone NO ............. Name of Contractor~.'~.~ .... Address ~~,~.~.y...Phone ~Z ~5.Z~' PLOT DIAGRAM Locate dearly and d~stmctlv all buddings, whether ex~stmg or proposed, and red,cate all set-back ~mensions from property hnes. Gwe street and block numbers or descripbon according to deed, and show street names and indicate whether interior or corner lot STATE OF NEW"WORK,' ~ ~ . . & ~/ . COUN~ OF ............................ ) ~w~ o~ u¢~R¢ S, / ....... ~ .................................. bein~ dulg swom~ deposes ond s~ys that he is the (N~me o~ mdividuol sionin~ ~pplic~tion) .so o .............. .................................................................................... (Contr~ctor~ o~ent, cor~oroto officer, etc ) of soid owner or owners, ond is dulg ,uthorized to perform or have performed the soid work ond to m~ke and this opplicotion~ that oll st~t~ents contained in th~s opplic~tion ore true to the best o{ his knowledge ond behe~ ~nd that the work will be performed in the monner set {orth m the opp~ic~p filed t~erewith ~ Sworn to before me this (C~ ~0 ..... ~ ......... y ~~7 ~ ....... ~ (Signature of applicant) ...... ]SZ 0 ~ ,folk ~0'