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Home My WebLink About2553-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN GLERK'$ OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~..D-~06 ............ Date ..................... .~,.e...~..~.,.~..a...~.~....2.... , 19....6..5.. THIS CERTIFIES that the building located at .... .~.~l/J.~..~J~/~..~.~.. ~...~.~.~...~..t,.. ............ Street Map No. " ..... Block No ......... ..-..'..'...-..-..."Cot No. - ...... conforms substanhally to the A, pphcation for Building Permit heretofore filed in this office dated ............... ~)~Oh~'...~4 ........................... 19.6.~.. pursuant to which Building Permit No..~.~.~...~. doted ........ QC~:I]~...~ ........................ 19..6.~., was ~ssued, and conforms to all of the requ~ rements of the applicable provisions of the law. The occupancy for which this certificate is zssued is ........ The certificate is issued to ............................... .~........~.,;....~...R;~ .......................................................... (owner, lessee or tenant) of the aforesaid building. FO~ 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? 2553 z Permission is hereby granted to: ~on~... ~tm,~lua....A/~....l~, J~.. J~Len~. ............... pursuant to application doted ................................. 01~to]:le~.....I.~., 19..6~.., and approved by the Budding Inspector Fee $...~ ............ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. ........... ~pp~oved ........................................ , ~9 ........ Permit ~o .......... Disapproved o/c ...... ................. ......................................... (Buildin~ ~spector) Application No. (~ '~-'~ APPLICATION FOR BUILDING PERMIT ...................... ............ . , .. INSTRUCTIONS o Th~s application must be completely filled m by typewriter or m ink and submitted m duplicate to the Buildin Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjmning premises or public streets areas, and gw~ng a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatio, c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of th~s application, the Building Inspector will issue o Buffding Permit to the applicant. Su- permit shall be kept on the premises evadable for inspection throughout the progress of the work. e. No building shall be occupied or used jn whole or in part for any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector. APPLICATION IS HER. EBY MADE to the Building Department for the ,ssuonce of a Building Permit pursuant to tJ Building Zone Ordinance of the Town of Southold, Suffolk County, New Yo~k, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as harem describe The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signo~re of applicant, or name, if o corporation) ............................... ..... St6te whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build Nome of owner of premises ..... ....~...C.',.~., ...... ~~ ....................................................................................... If applicant ~s o corporate, signature of duly authorized officer. (Nome and t~tle of corporate officer) 1. Location of land on which proposed work will be done. Map No' . ........................................... Lot No: ............... 2. State ex;sting use and occupancy of premises and intended use and occupancy of proposed construction: a I:x~sting use and occupancy ...................... ~. ...................................................................................................... b. Intended use and occupancy .... ~..~..~ ..................................................................................................... 3. Nature of work (check wMch applicable): New Budding .................. Addition ...._./?~... ........ Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Estimated Cost ..... .~..¢ ................................................. Fee ......................................................................................... (to be paid on filing this apphcation) 5. If dwelling, number of dwelling umts ......... ./. ................. Number of dwelling units on each floor ..... ../. .................. If garage, number of cars .......................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. '~ '~ ~ ~ 3 '~" ~- '~" 7. Dimensions of ex~shng structures, if any: Front ..........................Rear .......................... Depth .......................... Height / -¢ ' Number of Stories / D~mens.ons of same structure with alteratjons or additions: Front .............................. Rear ............................ Depth ~' /7/2'1 Height ......... .~... ............... Number of Stories ..... ./. ................................. 8. Dimensions of enhre new construction: Front ...... ..~..?...r. ............ Rear '7,-6 / Depth //~ ' Height ....... ./...?.../, ............ Number of Stories ...... ./. .................... 9. Size of lot. Front ....... .~...~.; ............ Rear ...... ..~....~...'. ............ Depth .../.....~....~...f ............... 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. Zone or use district m which premises are situated ...... ~....~ ....................................................................... 12. Does proposed construction wolate any zoning law, ordinance or regulation? .... ..."~......c~...: ................................... 13. Name of Owner of premises ..~,.~..,..~~ ........ Address ....... ~~ ............. Phone Ho ................... NameName of°f ContractorArCh~tect ..............................~....~.....~....~...~.....~:...'r..~x...~."~ ~/~ ~--""'"*~'-- ...... ..... AddressAddress liii~~iiill Phonephone NONo.~.../~..~.i,/..~.4 ................... v PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro~ property hnes. Give street and black numbers or description according to deed, and show street names and ind~cat whether interior or corner lot. STATE OF NEW YORK~ COUNTY OF ...~.~£~..~..~. .......... ~ S.S ..................... .~'~.. ~'.. ...... ..~..~...~..~./~..../~... ............................... being duly sworn, deposes and says that he is the applica (Name of individual signing application) above named. He is the ..................... C...~.(~...~.~/..~'.~..~.../.f. .............................................................................................. (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 f this application; that all statements contained in this application ore true to the best of his knowledge and beh~ and that the work will be performed in the manner set forth in the application filed therewith. before me this Sworn t;z/..~..{.., day of .......... ~...~....7,. ....................... , 19"~'"~ ................... ~ .~ .~ ~ Notary Public~".~.:~.~./~/.. ..... ].,:~.~,Zq,..4.~,x~COHSty ..... y-'~Signot~'~;"o~' ;~l~ii;;'~¥i .......................