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Home My WebLink About2515-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THiS CERTIFIES that the building located at .Z~,~etr,..~ner..Git'~el~]~ .................. Street conf~rms substantially to the Application for Building Permit heretofore filed in this office dated ...... I~la~;ei:~l::..J.1 ............................... , 19.~.4.. pursuant to which Building Permit No..~J..~..Z date~J . .~l~'...,1,&r ..................... , 19..~., was ~ssued, and conforms to all of the requirements o~ tl3e applicable provisions of the law. The occupancy for which th~s certificate is ~ssued is / //Th;~ certificate is issued to ..~Jeo~JjJ~..~,...W&~eli~o... (owner, lessee or tenant) // of *~he aforesaid building Building Inspector FOR34[ 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? 2515 z Permission is hereby granted to: ............ ~e..'~.~..~tenke .......................... to .. 3~a5,16... a~.. &d4f~t,:l,~.. eh.-eu~. ~a~o~,ng.. ~m~.l..~ ....................................................... at premises located at ..... ][l~ll~,..;[~Jl~ ............................................................................................... pursuant to application dated ................................ I~e~el~tl~.....~.9..(:~., and approved by the Build,ng Inspector Fee $"'~'wO0 ........... Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT .o. ......................... ....... INSTRUCTIONS a. 'Fh~s application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildinc Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o, areas, and giving a detailed description of layout of propertymust be drawn on the d~agram which is part of this application c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d. Upon approval af th~s application, the Building Inspector will issue a Building Permit to the applicant. Suck 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 m part For any purpose whatever unhl a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION 1S 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 apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. (S~gnatu~ of applicant, or nome, if a corporation) .......... ..... ....... ....... (Address of applicant) J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ./4~..~. ...... ..~..:.......~)...~ ~J If applicant rs a corporate, signature aT duly authorized officer. (Name and t,tle of corporate officer} 1. Location of land on which proposed work will be done. Map No ................ ~ ...................... Lot No: .;:.:.~............ .. .. Street and Number Mumcipality ' ' 2. State existing use and occupancy of p~nded use and occupancy of proposed construction: a. Ex~sting use and occupancy .................................................................................................................................. ~ b. Intended use and occupancy ............ ~~ ....................................................................................... v/ 3. Nature of work (check which applicable): New Building .................. Addition ................. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Eshmated Cost ............................................................ Fee ........................................................................................ (to be paid on filing this application) .5. If dwelhng, number of dwelling units ....... ~ ......... Number of dwelling 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, if any: Front ......... ~.f. ........... Rear .......... .~..¥. .......... Depth ......... ).~' ............. Height ~.....,'.(~ ............. Number of Stories ....... ~ ........................................................................................... Dimensions of same structure with alterations or addlbons: Front ............ ~..~. .............. Rear '~ > ) ' ..~/~lh...~ ............. Number of Stories ..~.~,~, Depth .......... :'~ ................. Height ' 8. D~mens~ons of enbre new construction: Front ........... ~ ............... Rear .......................... Depth .)..~. .................... Height .~t~...I/~ ............ ' Number of Stories' ............................ 9. Size of lot: Front ........... .Z9 ............. Rear ................ .!.¥ ........ Depth ............. .~...z~... ........... 10. Dote of Purchase ..... ~c~¢~....I.~.~ ...................... Name of Former Owner :~~...~ ......... 11. Zone or use district m which premises are situated ..................... /~. ...................................................................... 12. Does proposed construction,.¥iolate any zoning law, ordinance, . ~- z ___ar regulation? .................................................... 13 Name of Owner of premises/~Jr....~........~-r~¢~.---~ ....... Address~.~,...~¢~ ..... Phone No..~ / Name of Architect ................. ,~' ................................ Address ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property hnes. Give street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. STATE OF NE'W~ORI~,, ,,) ~ ~ ¢ '~ "/ - (Nar~ of individual signing application) ~ above named. He ~s 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 th~s apphcat~on, that oil statements contained in this application ore true to the best of his knowledge and bell and that the work wdl be per. formed in the manner set forth in the application filed therewith. Sworn toT~fore me this ~l~ ~,,_~_ /.. ~ ~.,~ ~ ,~ , ........ // ........ dayof../ ....................... 4' ¢ kb_ /,... ............ ..... ............................ Notary Public,J..)...J~.~..~...(~.,....~:, .... C~lunty ///(Signature of applicant) duly sworn, deposes and says that he is the applio