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Home My WebLink About2569-zFOt~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ..m...~2..~2 ........... Dote ................... O~,.~:~e~. :13~ ........ , 19 ~5.. THIS CERTIFIES that the building located at ..... ~£n~- ~.l~ee. ROa~..gt~tm.~Og~U~treet Map No ..... }'*~ ........... Block No ....... ~ ....... Lot No .................... ~ ..................................... conforms substant,ally to the Appl,cation for Build,ng Permit heretofore f,led ,n this office dated ........................ Oe.~o~e~..20 ............. , 19..~. pursuant to which Budding Permit No dated ........... ~t*m/~= .5 ............ , 19...64. was ~ssued, and conforms to all of the requirements of the applicable prows,ohs of the law. The occupancy for wh,ch th,s cert,ficote ~s issued ,s ....... .................................................... .~.~,~.~.~f~X~.. ~. ~ .~.~-~-~e ~;...~¢.e ~ ),.¢l~t~.e. ....................................... The certificate is issued to ...... ~.O}LO...~x~e~ .............................................................................. (owner, lessee or tenant) of the aforesaid building 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? 2569 Z Permission is hereby granted to: IlJLdgley &. ~;R.~....~JCL... Jbhn.. Gr~ ................... .............. .~t,~ho~a~ ........................................... to .... ~..1.d... Jl~u.. Sd~,t f,l.on..an., an. ~l,s.t~a~...,~,~.l~ng ...................................................... at premises located at ........ ~,lll~..t~. ............ N~Ig~i~.l,:l,..~'~l'q~l ............................................................... .......................................... · ~..t~'.e~..road~ ..... Cu$~hog~e ...................................................... pursuant to application dated .......................... O~.'~Jilb~.....]~,O ......... 19.~1~., and approved by the Building Inspector Fee $..~.~..,0~... ............ Buildmg Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDI~IG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application N .o~.. ~.~...~.. ........... APPLICATION FOR BUILDING PERMIT Date ...Q0.~.f}]~.e,~...3.0. ......................... , 19..~ INSTRUCTIONS a. Th~s application must be completely filled in by typewnter or in mk and submitted in duplicate to the Buildin~ Inspector. b. Plot plan showing location of lot and of buildings on p remmes, relationship to adjoining premises or public streets o areas, and g~wng a detaded description of layout of property must be drown on the d~agram which is part of thi~ applica tiaa. c. The work covered by this apphcat~on may not be commenced before ~ssuance of Budding Perm,t d Upon approval of this opphcotion, the Building Inspector will ~ssue a Budding Permit to the applicant. Sud permit shall be kept on the pram)sas available for inspection throughout the progress of the work. e No budding shall be occupied or used in whole or m pa rt for any purpose whatever until a Certificate of Occupanc' shall have been granted by the Budding Inspector APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Budding Permit pursuant to th,_ Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ Regulations for the construction of buddings, addmons, alterat~c~ns, or for removal or demoht~on, as herein described. The apphcant agrees to comply with all apphcable laws, ord)nances and regulations. ~ ... ~,ti .ct~ .Z..e. ~... ~... ~.Z.o.~..~ .~ ................................................... (S~gnature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician plumber or budder .............................. .~.~.~.~...C..c~:~.¢.~ ................................................................................................................. Name of owner of premises ...~.O..b~..Cr~.$~f~l. ............................................................................................................. If applicant ~s a, corporate, signature of duly authorized officer. ............. (Name and title of corporate officer) 1. Location of land on which proposed work wdl be done Map No ........................................ Lot No.: ...................... Street and Number ..?..J,~e....~;~.e...o....~...o.~ ....................... O..i.k~..qj2~,~.~f~ ................................................................ Mumc,pahty 2 State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction. a Ex~sting use and occupancy .... .~...q.m...m..e...~...~.e..s...:i:..ct.9~..o..~ ...................................................................................... b. Intended use and occupancy S~eZ' ~es~{ie~¢e ~.~.....c{. ~...~ ................................................... 3 Nature of work (check which apphcable). New Buildmg ..... Addmon .... ~ ...........Alteration Repair .............. Remova! ............. Demolition ............ Other Work (Describe) ................. 4 Estimated Cost ..... ~ .!_Q0 0..sO.Q ............................. Fee ..... ~.~.., .O.Q ........................................................... (to be pa~d on filing th~s application) 5 If dwelling, number of dwelhng umts ....................... Number of dwelhng units on each floor ....................... If garage, number of cars ........................................................................................................................ 6 If busmess, commeroal or mixed occupancy, specify nature .and extent of each type of use ............................... 7 Dimensions of existmg structures, ~f any Front ..... _3~?. .......... Rea~ ......... ~..t ........... Depth ....... ~.~.t. ............ Height ........... ~.~ .......... Number of Stones .... ~ ......................................................................................... D~mens~ons of same structure w~th alterations or addmons Front ........ ~3.~)..t. .............. Rear ....... ].~.! ............... Depth ........ ~]~..~ .................. Hmght ....... ].~.t. ............ Number of Stories ........ .~. ..................... 8. D~mens~ons of entire new construchon. Front .......................... Rear .............................Depth ........................ Height ............................ Number of Stones ........................ 9 S~ze of lot' Front ..... ~,0. D.! ................ Rear ....... .~.Q.0.~ ...........Depth .............. ]..5.q.t. ....... 10. Date of Purchase ............. .$.~...~../t ................................ Nam~ of Former Owner ...~.~...g...e..Z.....~..e...m..$..~..e. ............. 11. Zone or use district in which premises are situated ........ .&....~..o..g.e .................................................................... 12. Does proposed construction violate any zonmg law, ordinance or regulatlon~ ........... ~I,Q ......................................... 13. Name of Owner of premises ~.f~g,...~.~l~.~ .......... Address .......................................... Phone No .............. Name of Architect ............................................. Address ................................................ Phone No .............. Name of Contractor]~[~.q],g~,.~.~...~..~g~..~D, iP, ............ Address ..Q.U.1~.O~P,~I~.~. ........................ Phone No PLOT DIAGRAM Locate clearly and d~stmctly ali buddmgs, whether ex,stag or proposed, and ad,cate all set-back d~mensions fr, property hnes Gwe street and block numbers or description .according to deed, and show street names and md~cr J, .l whether ~ntenor or corner lot. STATE OF NEV~ Y(~K,,n- ) SS COUNTY OF ./.2.~...) · ..... :.~....~. ~.....~..~z'~J~ ............................... be,ng duty sworn, deposes and says that he is the applicar ~ of mdiwd~a~ s~gmng application) above named. He is the .... ~~ ............................................................................................................. (Contractor, agent, corporate officer, etc.) of said 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 in thru apphcat~on are true to the best of his knowledge and belief; an that the work wdl be performed ~n the manner set forth in the apphcation ~ded therewith__ Sworntobeforemeth,~,~...~,~...~.~ of ~~I-¢ ~ ~ ~ ~~ .......... .... . ...... ....... .... Notary Pubhc .~~%~~).,! ~ounty (S~gnature of applicant)