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Home My WebLink About2576-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..... Dee~.~.o~t..~,~..~o~se~..Tz,.a_~.].....~S~r]~eef Dr Mop oh~°...°.~.~...c..?.Le... Bbck ~o ..... ~ ............. Lot ~o...~(~ ........... C~t~, ..... ~.Z. .......... conforms substanbolly to the Application for Building Permit heretofore filed ~n thru office dated ..................................... ~Gvetal~e3~ ..... ~., 19.~,.~.. pursuant to which Building Permit No..,~..Z dated ............................ NctY/~-m.b. er...1 ~., 19..~.~., was issued, and conforms to all of the requirements of the applicable provismns of the Iow The occupancy for which this cerhficate ~s issued ~s ........ · .l~l,v~te..oae...~aaiJ~y..cl~e l.~.ir~ .............................................................................................. The certifmate is msued to ..~ozta~d...Ca~.d ......................... O.l~lP~. ............................................ (owner, lessee or tenot3t) of the aforesaid building H. D. Approval ~arch 1965 by R. Villa ............ ....... ..... ..................... Building Inspector [ ~ FOItM NO. ~ TOWN OF SOOTHOI. O 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? 2576 z Date .............................. JJl~e~'...];O..., 19..~3~ Permission is hereby granted to: George A2~.r ~'""AJ(~"'l)mmtd" ~ea'~ ........................... ........ · ~u, te.hogtm i...N.~ .~ ................................... to -B~.td- · -n~-- ~rm. - ~'~-~y' · · d~t'e.]-;~ .:~n~ .................................................................................... at premises located at .. ~jO~i;....~ip..~.O,$ ...... ]~jl~..~Otlrt~. ................................................................ ............................................. ......................................... ........................................................... ~l,a~o~l~o g,ae.~. · · t~ ~. ~ ................................................................... pursuant to application dated .......................... JJO~'~qlltJ~l~'"'JJ ......... 19.~1,., and approved by the Building Inspector Fee $.-~!'0100' ......... FOI~ ~0. 1 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ......... APPLICATION FOR BUILDING PERMIT Dote .................................................,///..~'...~..~. ~/ ......... , 19 ............ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION 'IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply w~th all applicable laws, ordinances, building code and reg~ ......... ;;;i ......... Name of owner of premises ..................................................................................................................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer~ 1. Locat on of land on which pro ose. wokw be one Mo No' ~x//~/!/~0 . ~l~.. NJ ! 0 p sed~wo.r ~j,~be ~ . p ....................................... Lot ..o: .................... Street and Number .~. ,~...~.._~Z.~,,. ...... ~ ..... ~~.1 ..... ~..~,../Z,: ............ ~,,~,~ ......... ~J ) Mumc~pality ' V State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Ex~sting use and occupancy ................................................................................................................................... b. Intended use and occupancy .................................................................................................. 3 Nature of work (check which apphcable): New Building .................. Addition .................. Alteration ................ Repair .................... Removal .................... Dernolihon .................... Other Work (Describe) .................................... 4. Est,mated Cost ..... .?..../.73.'~...~..~/~. .................................. Fee ........................................................................................ (to be pa~d on filing this application) 5. If dwelhng, number of dwelling units ........... .~-. ............. Number of dwelling umts on each floor ....... ~ ............... If garage, number of cars /' 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D~mensions of existing structures, Jf any: Front ..........................Rear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................. D~mens~ons of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of ant,re new construct,on' Front ............ ~.3 ........... Rear ........... ~.~ ........... Depth ......~.~.. ............. Height .............. ......... Number of Stories .......... ./..Y...~. ........... 9. Size of lot: Front ......... /.],.~..:.~.Z ..... Rear ..... (/..~.:..~..~ ......... Depth .../..~..~..:..7..~.. ............. 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 1 1 Zone or use district in which premises are s~tuated ............................................................................................... 12 Does proposed construction v~olate, any z~onmg law, ordinance or, r,~gulatio~ .,, ..... ~ .................................... 13. Name of Owner of premises,~..¢n,~..~ ................ Address ............. ~.~..~..~,... Phone No ................... Name of Architect ............................. ,~./2 .................... Address Phone No ................... Name of Contractor .~....~...~:~ ............... Address ~ii~iiii~iiiii Phone No. ?..C...~......~?.../. 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 indica[ whether interior or corner lot. 0' ............... ~ ........................................................... ~... ' g y wa , d p s and says that he is the applicaz ............................................................................................... (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 fi th~s application; that all statements contained in this application are true to the best of his knowledge and belie and that the work will be performed in the manner set forth m the apphcation filed therewith. Sworn to before me th~s ~r ~ .......................... day of ............................................ , 19 ........ . ................................. Notary Public, . ........................................................... County e of applicant) ....................... ;¸7