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Home My WebLink About2588-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building Iocoted ot .... .~.~ .... ~t~,.~P~...J~.~ .............................. Street Mop No ..... ~ ......... Block No..~ ............. Lot No. :~ ...... J~.:~.~.~.~.t ...... .~..,..~'.-. ............... conforms substantially to the Application for Building Permit heretofore filed m this office dated ........................................ .~'..O...~..e...~.~.e..~....~., 19...~... pursuant to which Building Permit No .... .~..~.8...~....2[ dated ......................... ~[OTg.~tf~Z'.....],c~.., 19..~...., was issued, and conforms to all of the requmrements of the applicable provisions of the law. The occupancy for whmh th~s cerhficate is issued ~s ........ ........... t~.v.a.t.,e .. erie.. ~'e,~.i.t~..d,,~et. ti.ni~ ................................................................................... The cerhficate is issued to ..~2~.&~;~....~.,...~l~D.~l.t ............... (}j~'~ ....................................... (owner, lessee or tenant) of the aforesaid building H.D, Approval April 2t 196~ by R, Villa .... ............................ Building Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTNIENT 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? 2588 Z Date ........................ JJl~4~J~l~.....],~ ......, 19...~:~t~ Permission is hereby granted to: T~'.....ll~i~ltm.....~tC....~a,~¢~,i.a~.. t~z,~l~t ........................ · O~te~t ......................................... to ..lln~t~.. ;ne~.. ene..fe~d:tT..dve-l.t~ ................................................................................... at premises located of ...... ~P/~.....]~IIRI~I~..~I~ .................................................................................... ............................................................ ~.~**~.~.... ~.,L .................................................................... pursuant to applicatioh dated ................................ ~..]~1~it~., 19..l~1~., and approved by the Building Inspector Fee $..~_t)_ cji:lO .......... Building Inspector $-9 $CHD SUFFOLK OOUNTY DEPARTMENT OF HEALTH APt~ - 2 1965 Bldg. Permit No. The sewage disposal facilities for a structure located at · -(Give deed lOca'cion) ~/~ ~, ~Vo ~ ~q~l ....... · o ]~ ~ I.,o / V ~ I~ ..... l~ve been ir,~pe¢'ced l~r 'chi~ Del~Cmen'c ~r~ £om"~cl District Engineer FOF.,M NO. 1 TOWN OF SOUTHOI..D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 1c) ........ Permit No...............,................. Application APPLICATION FOR BUILDING PERMIT Dote ,44n×,"? INSTRUCTIONS a. Thzs applicatzon must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o 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 Budding Inspector will issue a Budding Permit to the applicant. Sud -permit shall be kept on the premises available for inspection throughout the progress of the work. e. No budding shall be occupied or used in whole or ~n pa rt For any purpose whatever untd a Certificate of Occupanc} shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Budding Permit pursuant to thf Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances o~ Regulations, for the censtruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ........ ......... ................... ...... .......................... · ' ' (A~[dress of applicarYt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No 'u ......................................... Lot No: .................... Street and Number .....~...~...~....~..'. ..... ...~...~.......'~...,...~....: ....... (/ Mumcipality ~' ............ 2. State ex,sting use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy . ~ · 3. Nature of work (check which applicable): New Budding -.~. ........ Addition .................. Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4, Estimated Cost ............................................................ Fee ........................................................................................ (to be paid on filing this apphcatJon) .5. If dwelling, number of dwelling units ....... .1. ................... Number of dwelling units on each floor ..... ~ ................... If garage, number of cars ......................................................................................................................................... 6. If business, commercial or rnJxed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ ' .... ..~'../....'. .............. Depth ....~....?.. .............. 8. D~mensions of entire new construction: Front ...... .~../. ............... Rear Height ....~-'..~...L..: .............. Number of Stories .... ./. ..................... 9. Size of lot: Front //*~'' ' Rear ..... ./../...,~....z. ............ Depth / ~- ~ ' 10. Date of Purchase ....... .~..~..,..o~..:....../..~.....~...~.. ................. Name of Former Owner /~.~¢~'~..~....~ .............. 11 Zone or use dfstrict in which premises are situated....~.: ........................................................................... 12. Does proposed construction~, ,~/ ,~. ] ~ -~._vi°la'te an~ zoning law, ordinance~~,,_,,,~or regulation? ..... ...'~....~:~... ........................... :~... 13. Name of Owner of premises ...C~.~..~..~~...Address ~.~'/~~...~..~.~,, Phone Name of Architect ........................ ......,...~........... ...... Address ............................................ Phone No .................. of Contractor 7.....~....~.. .............................. Address ......... ...1~...~ .......... Phone No.~..~...~.. Z./. ~..~. Name PLOT DIAGRAM Locate clearly and dishnctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro property hnes. Give street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. 1'7' STATE OF NDvV..5,Y~OR.I¢., COUNTY OF ..... ........... f S S. ............ ~..~..4/...~.......¢I~.~.,~../'Z4~./_Z.Z'i.Z'.. ........................................ being duly sworn, deposes and says that he is the applic (Nome of individuol s~gning application) above named. He is the .................................. .~..~..l~...~..f'~...~...Z..~../~ ............................................................................. (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 this apphcat~on, that all statements contained in th~s application are true to the best of his knowledge and bel and that the work w~ll be performed in the manner set forth m the application filed therewith. Sworn to before me th,s ............................................................., ......~.. Not~i ,~.,°.f.~.,,,--~."~'~!..J~,,~,~(~/~/... C6~n?'.~ "'~:f~'"~ (Signature of applicant)