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Home My WebLink About2541-zFOR~ NO. 4 TOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No Z...2Q~..~ .............. Date ......................... ,~.Ch.....l~ ........... , 19 .~.~'.. THIS CERTIFIES that the building located at ....E/S...l~ir.t..Roa~-..,S/~..So~ud..~,te.wS~ Map No ..... ~ ............. Block No Z;~ ...............Lot No :X,11:;X, ....... ~o~t. th(;kld, l...J[,.~, ..................... conforms substanhally to the Apphcahon for Building Permit heretofore filed ~n th~s office dated ......................................... ~p~5,1......9. ..... , 19(;~.... pursuant to which Bu,lding Permit No...?..~'..~.!L... dated ............................... J~;:ir.....2,~ ..... , 19.0.~..., was ~ssued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this cerhficate ~s ~ssued ~s ........ · l~.tV~;e .. etrle...£~ ~.ly. · 4]w%1.1 A ~ ......................................................................................... The certificate ~s issued to ........He,~tl~.~..P~,.J&cc~b;~..~r. .............. ~e~'. ........................................ (owner, lessee or tenant) of the aforesaid building H.D.kpproval March 1, 1965 by R. Villa ........... '~Building .......................C~' ~''~ ' nsl~~~ .......................... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 25 1 z Permission is hereby granted to: ..~......m~Jb... ~#.~1~1..I~. .................................... ................. ~.~t,~,c~gue ......................................... at premises located ot ...~J.....J~.~,..J~Q~W.e,... ~....,~O~l~]l,..~e~..~r~ ............................. ~outho!d ..~..Ac.ce~.~..~~..hg..~.~p~_~) ................................................................................. pursuant to application doted ............................. ~. ....... ~ ........... 19..~., ond approved by the Building Inspector Fee $..~t~.S...O~.. .......... $-9 SCHD SUFFOLK COUI@Y DZPARTi~E GE. I~!LTH Date Bldg. Permit No. TO "~IOM IT i~!Y CONCE?,h The sewage ~s~o~al facilities for a structure located at ...................................... have been i~ected by this Depa~ment and found to be sat~sffacto~y. District En~neer NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ..... ........ , Ig ...Perm,t No .... ....... Disonnroverl o/c ~ ~ ~ Z ~o ,~ ~ , ............................ ~.; .............................................. ........ ...... .... .............. .......... ..... .................................. (~uHdm~ Inspector) z ~"~; .__Z., Apphcation No ........................ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. Th~s applicahon must be completely filled m by typewnter or mmk and submitted ~n duplicate to the BuHdin. Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adlo~nmg premmes or pubhc streets o areas, and gwmg a detailed description of layout of property must be drawn on the diagram which is part of this apphcat~or c. The work covered by th~s apphcahon may not be commenced before ~ssuance of Budding Permit d Upon approval of thru apphcahon, the Building Inspector will ~ssue o Budding Permit to the opphcant Sud permit shall be kept on the premises available for inspection throughout the progress of the work e No building shall be occupied or used m whole or in pa rt far any purpose whatever untda Certificate of Occupanc: shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the tssuance of a Budding Permit pursuant to th,' BuHd~ng Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demohbon, as hereto descnbed The applicant agrees to comply with all applicable laws, ordinances and regulations (S~gnature of applicant, or name, ~f a corporation) (Add~'ess of applicant) State whether applicant ts owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ..................... ...... .~..r.,~,~ ~,.~ c~. ................................................................. If apphcant is a corporate, s~gnature of duly authorized officer ..................... ;::::-:'.~'. ;:Zi.::L: ;.,CZ.~. .......................... (Name and title of corporate officer) 1 Locahon of land on which proposed work will be done Map No ......................... Lot No Street and Number~'.'~¥~"~. ~.1 ..~.~.t~,~ .... ~ 0 kt ~J/iU~.~-~. ~u.~- ,..D.k/..~Jj.~...~.'f...~.~..LD...~,.~x ...... Mun~c~pahty 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction' a Ex~sting use and occupancy ~-J/~ c I~, b Intended use and occupancy ....~¢.~.D .~...~.f¢..~. ...................................................... 3. Nature of heck wh,ch apphcable) New Bu,ld,n ............ Add,t,on ........... ~~ ............ Repair ..............._.~.k.~Sm~vcl~L~. .......... Demohtion .......... Other Work (Describe) .J~;).~$.~ ... 4 Estimated Cost ........................................................ Fee ~ . ...... (to be pa~d on fihng this applicati~on~ 5. If dwelhng, number of dwelhng umts ........ Number of dwelling umts on each floor If garage, number of cars ................................... 6 If bus~ness, commercial or m~xed occupancy, specify nature.and extent of each type of use ..................... 7 D~mensions of ex~stmg structures, ~f any Front ....... Rear .............. Depth Height ........................ Number of Stones ..................................................................................... Dimensions of same structure w~th alterations or addmons Front .................. Rear ................... Depth ........................... Height ..................... --,'~'t'~Number of Stones ~S~,. ....................... 8 D~mens~onstol~ entire new construchon Front . Z)g.l'~.,; " Rear ...................... Depth ........................... · Number of Stones ..... Height ................. 'j"¢5 Q 7 ~ ~ ..... ~L ~ ~3 9 S~ze of lot Front .......... r~ ~'~'~'~ -.,,~ .- C g~'~ear~,cT" ...................... Depth ~'."~e't3'~'D~ ~' 10 Date of Purchase .......................................... Nc~f.Former Owner ... 1 1 Zone or use d~stnct m which premises are s~tuated. 12 Does proposed construct,on ~o~e~[%r~r]g law, ord,nanc~;) ........................................ 13 Name of Owner of premises ....................... Address .C~. ~.?t. fl..~.~?...~. ......... Phone No ........ Name of Architect .............................. Address ................................. Phone No .................. Name of Contractor ....................................... Address ....................................... Phone No .................. PLOT DIAGRAM Locate clearly and d~stmctly all butldmgs, whether existing or proposed, and ~ndfcate all set-back d~menstons fror property hnes G~ve street and block numbers or description according to deed, and show street names and md~cot whether interior or corner lot STATE OF YORK, ) S S COUNTY ............ ) ........ ~'~;M; Z';;g;;~;Z;f&'~;~'&"G;f;Z;G%¥" duly sworn, deposes and says that he ,s the appl,ca, ~bove named He ~s the ............................................................................................... ; ................ (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the sa~d work and to make and ft th~s apphcahon; that all statements contained m th~s applicahon are true to the best of h~s knowledge and behe and that the work will be performed m the manner set forth In the apphcat~on filed therewith Sworn.~.~...~.to b~fore me ofthis, , . ~,o.~ -.. ,....~ ~Or~-..., ..~?"¢ ~ r-¢~,. ~'~ O~ .~~ . .... , a , ~ ....................... ' (S,~noT~ of opphc~nt~ ..................