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Home My WebLink About2571-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .. ,l~sot3..D~'~er..C,t~,chog~e ............ Street Map No ..31~3[ ............Block No ...... ~ ........ Lot No .........Z;X;Z .................................................... conforms substanhally to the Apphcahon for Building Permit heretofore filed m thru office dated .................................. lllO~e~...4 ., 19...64 pursuant to which Budding Permit No25.7.3.. ~... dated ....................... ,~(;~eatl:~..$...., 19.6~,, wes ~ssued, and conforms to all of the requirements of the applicable prows~ons of the law. The occupancy for which th~s cerhficate ~s ~ssued Is ........ ............................................. add/~k-ion..t~o..~ununex..~:ea/.~len~e. .............................................. The cerhficate is issued tq]'ohtl...D~i,a~ey .................................................................................. (owner, lessee or tenant) of the aforesaid building Budding Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, hi. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2571 Z Date ........................... ]1[¢~4~111~'......~ ...... , 19..~. Permission ~s hereby granted to' N~dglel...~..Ho~.t, on.,..~.C...J~..DeLaney ......... .................... C~utehegt~e ...................................... to .. ~l~.t id,.. ~.. ad&:~{torl., o~1.. ~Et.. eor4~ ~ Ler~'' ~]:'liX~ ....................................................... at premises located at .... ~atl41~o~,.~.~e ............................................................................................ ...~. .............................................. Cut~c~ ........................................................................................ pursuant to application dated ............................. ~_.,)~l~be~.....¥...., 19..~, and approved by the Building Inspector Fee $ ..... ~'.,.~ ......... F~RM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI. D, N. Y. Approved ~ ~' .~......~..Z..~.~ ........................................ , ~9...i!...Perm~ No.. Disapproved a/c~~ ........................ ........................ APPLICATION FOR BUILDING PERMIT Date ....... :,1~ f~.~.~.t'~, f~ ~'. ......... /~ .............. , 19....6 INSTRUCTIONS o. This apphcotion must be completely filled in by typewriter or in mk and submitted in duphcote to the Buildir Inspector b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or pubhc streets, areas, and g~vmg a detaded description of layout of property must be drown on the d~agram which is part of th~ applio tion c The work covered by this opphcot~on may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. permit shall be kept on the premises ava,lable for mspectlon throughout the progress of the work. e No building shall be occupied or used in whole or m part for any purpose whatever until a Certificate of Occupan shall hove been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Budding De-p~rtment for the issuance of o Building Permit pursuant to fi Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances , Regulations for the construction of buildings, additions alterations, or for removal or demolition, as herein describe, The apphcont agrees to comply with all apphcable lows, ordinances and regulations. ........ ................................................ (Signature of opphcant, or name, ~f a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde .................. g..q .......................................................................................................................... Name of owner of premises ..... .Z..0.~.-...l~.~.~,.~t,.e.~. .......................................................................................................... If applicant ~s o corporate, s~gnoture of duly authorized officer (Name and t~tle of corporate o ~cer) 1. Location of land on which proposed work will be done Map No.' ........................................ Lot No.: ................... Street and Number ...........~.~.~.q,.q..~).~-.L~M.~. ........................................ ~ ~2ZD6~. ............................................... Municipahty 2 State existing use and occupancy of premises and intended use and occupancy of proposed construction. ~ ~S~ ~Se ~ad om~p~a~w ... ~ ......... ~...~.~ ....................................................................................... Su~er r~sid~¢~ ~F~2~/ b. ~n~ended use ~nd occup~mcy ..................................... /.~.~%~ ....9 .................................................... 3. Nature of work (check which applicable) New Budding ............... Addition ...... .~. ........ Alteration ............... Repair ......... Remora! ........... Demoht~on ........ Other Work (Describe) .................. 4. Estimated Cost ............ ~.I,QD.0.~.0.0 .......................... Fee ........ ~'5,QQ ....... (to be pa~d on fihng th~s application) 5 If dwelhng, number of dwelhng umts ............................ Number of dwelhng umts on each floor ....................... If garage, number of cars .............................................. 6 If business, commeroal or m~xed occupancy, specify nature and extent of each type of use .............................. 7 D,menmons of existing structures, ,f any Front ...... ~.6.! .............. Rear ........... ~.~..~ ........... Depth ......... .2...2..~. ........... Height ...... ~..2..~. .............. Number of Stones ........ ]- ........................................................................................ Dimenmons of same structure with alterations or add,hans Front ............................. Rear ............................ Depth ............................ Height .........................Number of Stones ............................... 8. D~mens~ons of entire new construction- Front ............................. Rear ............................. Depth .......................... Height .......................Number of Stones ............................ 9. S,ze of lot: Front ........ 7.~.t. .......... Rear ..........7~5' .............. Depth ................ ~.~.6..'. ..... 10 Date of Purchase ..... . .].. 9. ~5. .2. ................................ Name of Former Owner .................................................... 1 1. Zone or use d~stnct in which premises are situated .......... ~, .~ ..................................................................... 12. Does proposed construction v~olate any zoning law, ordtnance or regulation~ .......................................................... 13 Name of Owner of premises~..O..h..-rl.....D..e.]r'.a;..D..e.~' Address l~.~O ~L~ioz~Doi~t ]{cl.Dhono No. .......... B z~oZ~...62. ;...~ ~.F.!-oi~l~ ................. Name of Arch,tect ................................................... Address ............................................... Phone No ............... Name of Contractor .L'?.i~E,l.~r...~..~%Ol~t~.Q~ ......... Address ..0.~l,tC~,~,~.~ ......................... Phone No.l~..~.Zt..~.6..~.7. PLOT DIAGRAM Locate clearly and d~stmctly ail buddings, whether ex~stmg or proposed, and indicate all set-back d~menmons fro property lines G~ve street and block numbers or de~F?~ion according to deed, and show street names and indict whether mtenor or corner lot t STATE OF NEW Y~RI~, ) S S COUNTY OF.~ ......... ) .... ..~..~-- .~n..." ' 2~...~-- ....................................... be,ng duly sworn, deposes and says that he is the applica, (N~"of mdiwc~a! signing application) above named He is the ..u~x.~.c~.~ .................................................................................... ~ ............................... (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 fde tk apphcat~on, that oil statements contained m th~s apphcation are true to the best of hm knowledge and belief, a~ that the work wdl be performed ~n the manner set forth in the apphcat~on fded therewith. Sworn..~..to before me thisf~ , ~ ~ ~' ]~,~._ ~~ Notary Public k.~<'.~.~.~.~~d?:.-.~.£~t~ty (Signature of app_hcant)