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Home My WebLink About2542-zFORUM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...Z..235.~. ......... Date .................;ranua,'¥..2Q ...... , 19.6.~.. THIS CERTIFIES that the building located at 'OiaJC ',t,~terl~ei' '8ottt. hO.T. cl .................. Street Map No .... ',1.'Jl;76 ....... Block No .... ~X~ .......... Lot No .. [79,.1.8.0.~2f8:l,.~.¢11~2 ............................. conforms substantially to the Apphcahon for Budding Permit heretofore filed m th~s office dated ................... O~.~l::~e~...? ......... , 196.4.. pursuant to which Budding Permit No "2~4~'.l~ dated ................ O¢ltC~l:~Z'..'/ .......... , 144 ...... was ~ssued, and conforms to all of the requirements of the applicable prov~smns of the law The occupancy for which th;s cerhficate ~s issued ~s ........ .............................. edd~:Ec~n-.~:o, orte..~&m~].y' .~et.1 ~.[-~j .................................................. The cerhficate is ~ssued to '"l~dgtJ~'il~"JJortol~ "£O~"J'l~i~'o'.~d"~/,;"..Smt.t.~ .......................... ~owner, ~essee or ten6-n-f) of the aforesaid buffdmg 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) 2542 Z Date ....................... ~l¢~tOJ3t~......~ ............ , 19...6i~ Permission is hereby granted to: ~l.6~le~..&..~o~-.~....4~¢.....~e~eta...A....~.t~... to ...... ~.Id...ma..e~lLd.~.t~.oz~..eva-.ea..ex/:s~r~..d~l~ .................................................... at premises located at ...~t~..~]l...~l~ ...... ~04~e..~..~ES%l~.t~ll .......................................... ................................... IL, SL....O~..kv~+ ....... I~e~t~.a3AL .................................................................... pursuant to application dated ............................ O~t~, ....................... 19....~ and approved by the Budding Inspector Fee $..~.0~. ............ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~ ........ Z ..... , 19..~....~. Approved .......................... .~...~. ........ , 19 ........ Perm~ No .............................. App,icotion .......... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. Th~s opplicohon must be completely filled m by typewriter or in ink and submitted in duplicate to the Buildir Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to odlommg premises or public streets areas, and giving o detaded description of layout of property must be drown on the d~ogrom which is port of this opplio tion c. The work covered by th~s opphcot~on may not be commenced before ~ssuonce of Budding Permit d Upon approval of th~s application, the Building Inspector will issue a Building Permit to the applicant. Suc 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 po rt for any purpose whatever untdo Certificate of Occupon, shall have been granted by the Building Inspector APPLICATION IS H.EREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to tF Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations far the construction of buildings, oddmons, alterations, or for removal or demohtion, os herein describec The applicant agrees to comply with oll opphcoble laws, ordinances and regulations .... ........ (S g ~atu~ ~pplicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, orc~rntect, engineer, general contractor, electrician, plumber or builde .............................. .G~..~i ...... oxt.~:~.~.o~ .................................................................................................................. Name of owner of premmes ........ [~'.O.,],.c~..~, ...... ~.Q~ ................................................................................................ If apphcant ~s a corporate, signature of duly authorized officer (Name and title of corporate officer) 179, t~0, ]. Locotion of land on which proposed work will be done Mop No' .....3-~.~..~ ......................... Lot No.; ~.$.~.,.~,.'~..~.... Street and Number ....~J~..,~'$.0,.~$ .................................. ~.O~L,~.o.~L~ .................................................................... Municipality 2 State existing use and occupancy of premises and Intended use and occupancy of proposed construction. o Existing use and occupancy ...... ,~...~.~OJ-.~/.. ~.~/k,!,~l~ ......... ~_~7' .............................................................. b Intended use and occupancy ]. ~,~.~2.~. c~',v81].i~.....~...~...~.~ / 3 Nature of work (check which applicable). New Budding .............. Addition ....~ ....... Alteration ..~ ............ Repair .... .~. ....... Removat .............. Demolmon ............ Other Work (Describe) ............. 4. Estimated Cost ..........~O.~.00.0~.0.0 ................ Fee..~5.~0.0. .............................................................. (to be paid on filing this apphcat~on) 5 If dwelling, number of dwelling units ............................ Number of dwelhng unmts on each floor ......................... If garage, number of cars ....... .O~.~. ................................................................................................. 6 If bumness, commercial or mixed occupancy, specify nature and extent of each type of use ................................. 7 Dimens,ons of existing structures, if any' Front...~gt. ............. Rear .... ...~. ?. ............. Depth ....... :.~.~.~. .............. Height ........... ],C~.? .......... Number of Stomas ...~r~ ...................................................................................................... D~mensions of same structure with alterations or addmons Front ........ ..~..? ............... Rear ......... . .~..~ .............. Depth ........... ~.8..~ .............. Height .......~P-.? .......... Number of Stories ...... ~.~..~.. .................. 8. D~mensions of entire new construction' Front .............................. Rear .............................. Depth ............................ Height ....................... Number of Stones ............................. ' 9. Size of lot: Front ..... .8...0..~. ............ Rear ...... .8...0..~. ................. Depth ......... ..1.~.0...1....~.1...~.. 10. Date of Purchase .I~.~,,1~9.5.~ ........................ Name of Former Owner .... ~.~..~.~....~..~'.~..O.?.. .................... 11. Zone or use district in which premmes are s~tuated ..... ~..~0.~. ........................................................................... 12 Does proposed construction v~olate any zoning ]aw, ordinance or regulation:~ .......... ~.O. ............................................. 13. Name of Owner of premise[t~.(~ .~,...~R~... Address .8..O.~.~.b,P,~.~. ............................ Phone No~CZ, Z.~..r..Z .~..~.. Name of Architect 0..~.~.~....~.~....~..9..O.~. ...................... Address .~...a..~..~...n.~;...R..!..~..~..?. ................... Phone No.~/..A.?..T..4..~...1.! Name of ContractoM$~;.],e~r...~...,l~.OY¢.O,~ ........... Address .G..~¢~.O~.~. .......................... Phone No.t~...~...'~..~ PLOT DIAGRAM Locate clearly and dmhnctly ali buddings, whether exmt~ng or proposed, and indicat~ all set-back d~mensions fror property hnes G~ve street and block numbers or description according to deed, and show street names and indicai whether ~ntenor or corner lot. STATE OF NE'v'~YORK. I .... COUNTY OF _ SS Curtis l~r~lqierl] 7, orton ...................................................................................... sworn, deposes and s~ys Sh~t he ~s ?he (Name of ~ndiv~dual s~gmng application) above named. He is the ................ ~.2f..~.~.9.~.2~ ........................................................................................................ (Contractor, agent, co~orate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and file th~ apphcahon; that all statements contained m th~s apphcat~on are true to the best of h~s knowledge and behef, that the work wdl be performed ~n the manner set forth in the apphcat~on filed therewith. Sworn to before me t~s f~h da~ ,October. 19~ ~ ~- ~- ' ~ ...............................................................7~ .~_~. , ..... ~~ _ ........ .... Notary Public ..Z~ ....... ~.~ .....~~a~st~t, 0t ~e, ~om (S~gnature of apphcant) ............... N~ 52 b/bBB10 Resld~nz m Su,~oJk County Comm~ss~oo Lxp~res ~,a~ch 30~