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Home My WebLink About2540-z' FOKM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTt~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .... ~..;~.;~.~. ......... Date oe~.obez ll ]9..6..S.... THIS CERTIFIES that the build,ng located atl~/J~..~Cl3.OO],..~..~[t~le...~..q.$~.~.,....~, q.t-...C~.o.c~eet Map No ....... ~ ...... Block No .... ~ ...... Lot No ................ ~ ......................................... conforms substantmlly to the Apphcat~on for Bu4dmg Permit heretofore filed ~n th~s office dated .................. ~.~,C~]:>I~' ..7. .............. , 19 .~.~.. pursuant to which Build,ng Permit No ...2..~..~...0....Z. dated .............. .Qt=.~Obe~.. ~ .............. , 19.~..4..., was ~ssued, and conforms to all of the requirements of the apphcable provisions of the law The occupancy for which this certificate ~s ~ssued ~s ........ .................................. .............................................................................. The cert, ficate is issued to ........ ...J~...~..?....~...O...~..l~....~.tt~.~.~.l...e..~.. ............................................................ (owner, lessee or tenant) of the aforesaid building Building inspector FORM NO. 2 TOWN OF $OUTHOLD 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? 2540 z Permission is hereby granted to: ............ · ]Li,verl~ea4 ............................................. to ]~.],~..ll~,¥...(~II~..:~ma~ ]~...dya~l_~:~ .................................................................................... ct premises located at .... *~/~.....l~e~l~O~tl~..~ ................................................................. .................................................... ~uteho~,e .................................................................................. pursuant to application doted ........................... ~t~]~F ....... .~ ........ 19..~1~, and approved by the Building Inspector FORM NO, 1 Approved ........................................ , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. 19 ........ Perm t No ................................ Application No.~......~, ...~, ./. ~...., .~... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o Th~s application must be completely filled in by typewriter or m ink and submitted in duplicate to the Buildi Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giving a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatic 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 msue a Budding Permit to the applicant. Su 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 ~or any purpose whatever until a Certificate of Occupan 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 t Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describr The applicant agrees to comply with all applicable lows, ordinances, building code and regulations. ....... .............................................. (S~gnature of applicant, or name, if a corporation) ..................... Ei.v. erhead ................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build: ....................................... .C ~.¢r.~J~z~. .............................................................................................................................. Nome of owner of premises ....... ,~,~...ZosJ. e..Bztdzilek ............................................................................................... If applicant ,s a corporate, signature of duly authorized officer (Name and title of corporate officer} 1. kocot,on of land on which proposed work will be done. Map No' . ......... ;T, TJ~ ........................ Lot No: ...... Street and Number ..... E;./E; ..... ~c. ho. ol...H~us.e..B, oad~...C.u~c, ho~;ue. ............................................................... Munic,pality 2. State existing use and occupancy of prem,ses and intended use and occupancy of proposed construction: a Ex,sting use and occupancy ...... ~fLQaEtt...].nD.d .............................................................................................. b. Intended use and occupancy . O~f~...~n~J~$,~'....~.ft~l,].;1.;Gg ............................................................................. 3 Nature of work (check which applicable): New Budding ...... ~ Addition .................. Alteration ................ Repair .................... Removal .................... Demohtion .................... Other Work (Describe) .................................... 4, Estimated Cost ..~,.~,,~..0..0.,.0. ........................................... Fee .......... .~,g. ........................................................................ (to be paid on filing this application) 5. If dwelhng, number of dwelling units ..... O~e ................ Number of dwelling units on each floor .......................... If garage, number of cars ...... Q~ ............................................................................................................................ 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D~mensions of ex~sting structures, Jf any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................. D,mens~ons of same structure with alterations or addihons: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..... ~,C) .................. Rear ....... ~'.Q ................ Depth .~.2. ................... Height ............................ Number of Stories ........ oZZe. ............. 9. Size of lot: Front ......... ],g.C} ........... Rear .......... ],.0.Q .......... Depth ...... 3..~8 ................... 10. Date of Purchase .................... :L.9.6.br. .......................... Name of Former Owner ..... ,.l:,~[::Lml~z,eJ~ .......................... 11. Zone or use distrmt in which premises are situated ............ }},~!. ........................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ......................... z~o ...................... 13. Name of Owner of premises ....}~....s..-.....~.g.9..J-..~.....,~l,Cl,~;~k~l~l~s ............................................ Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of ContractorC~t'~'l e&J.~,h.t,..~:~s ............ Address .....a~,vez'.h~,d ................. 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 NEW YORK, ) COUNTY OF .J~.O~t~ .............. ~ S.S. ........................ ~l.~,,1,fJ~.~l. ....... .T.~,.%~a.Z'.~ ............................... being duly sworn, deposes and says that he is the applic (Name of individual s~gning application) above named. He ~s the ....... .(~.g~gL~.O~ ...................................................................................................................... (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 application, that all statements contained in this application are true to the best of his knowledge and bel and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ~j~~ ................... ~....~. d?y ~fL~.~.~,ru~e~ob~. ............. , 19..~ b~TARY. ~u~,~:_lc, ~aatc~ ~f'~w ,¢oy~ ................................... Notary Public, '.~,§mJ~. S~,;~~..'~...... County ..~f¢7 (Signature of applic'm~t)