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Home My WebLink About2592-zFOEM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY ~ 2228 No ............................ Date ............................. ~e~ ..... ~ ........19...6~. THIS CERTIFIES that the building located at ~.~...~fl,~.~f)~...~e,l~ .................................Street Map No ...~ .......... B~ock No .... ~ ........... Lot No ..~ ....... .C.~.e.~.O.~?..~....~:.~.,. ............... conforms substanhally to the Applicahon for Building Permit heretofore filed in thru office dated ................................. ~.o,,~...e.,~..b...e.?......~.~...., 19......,.6~ pursuant to which Building Permit No ...~.~..~.~... dated ............................. ..~..O.Z.e..~...~..e.~..~...0, 19...6..~.., was ,ssued, and conforms to aJ, l-of the requ,rements of the applicable provisions of the law. The occupancy for which th~s cerhficate is ~ssued is ........ Private one ~ily d~elling The cert, ficate ,s ,ssued to ......O...~..e..~.~.?...~.....0..~.!.°..~..s..~...~. ................... .0....~....e..~.....-....~..~..~..~.~.?..~. .................. (owner, lessee or tenant) of the aforesaid build~ng. Building Inspecttr FORM: NO. ~ 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? 2592 Z Dote ............................... Permission is hereby granted to: ... lllhe~t~.. ~:lr~slr~ ..................................... .................. [lut~ho ~a~ ....................................... to -~at.l-d.. ~1~ .. ~ ..l'~t,l~..d~.~;t l,~ii[ .................................................................................... at premises located ot ~....~l[~O~..~l~ ..................................................................................... ............................................ G'~'t,o ~ ~,e t ..... .qo:E. ............................................................................. pursuant to application dated ......................... ~l;~r~]!)~.....:9~ ....... 19~.., and approved by the Budding Inspector Fee $...[0~.00. ........ B~hain~' In'pelto; '/' .......... FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~./.......~......L?..., 19. · ~..~:.! Approved ........................................ , 19 ........ Permit No ................................. D~sapproved a/c ................ ~. .................... ~ ...................... APPLICATION FOR BUILDING PERMIT Date.....~... .................................................. , 1 9..(...V.. INSTRUCTIONS a. This application must be completely filled in by typewriter or m ink and submitted in duplicate to the Buildir Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adloining premises or public streets areas, and g~ving 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 ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector w~ll issue a Building Permit to the applicant. Suc 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 Occupan, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances · Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe. The apphcant agrees to comply with all applicable laws, ord[nancesz~ building code and_regulations. (Signatu/~of applicant, or name, Jfa corporation) ..................... ..... b...:..v... ..................... (AddressUof applicant) ! State wheth, e~applicant is owner, lessee, agent~ architect, engineer, general contractor, electrician, plumber or builde Name of owner of premises ..~,...-~*<.~,~.....k~_~:~...~.. ...... ~ .......................................................................................... If applicant ~s a corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) location of land on which proposed work will be done. Map No' . ....... .Z..~..: ...... i ...................... Lot No' ...~... ............ Street and Number ...~..~.~..I~,.¢,...~-~. ~.~. -- ..~.~.' ~.'w~ ")~un~ipalit~ ..................................... ~" .............. State ex~shng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .... /,~.~ ...... ~.... ..... 3. Nature of work (check which applicable): New Budding ...1:~. .......... Addition .................. Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................. (to be paid 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 ex~sting structures, if any: Front .......................... Rear .......................... Depth ......................... Height ............................ Number of Stones ............................................................................................................. D~mens~ons of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construct,on: Front ....... ..~......~. ............ Rear ........ .k..~.~ ............. Depth ....'~.....~. ............... Height ...... ~/...~.. ............... Number of Stories ....... ~ ....... Date of Purchase ...~....~.~..'~ ........... Name of Former Owner ./~.L(..r~¢.~.(~..-~...: ........... 10. 11 Zone or use d str cf'in which premises are situated ...... 12. Does proposed construction violate any zoning law, ordinance or. regulahon; 13 Name of Owner of premises ~,~-~:..-~-..~...Address ....~.~.~ .~.J~.~...( Phone ~.~...9...('Z.~ Name of Architect ...................................................... Address ............................................ Phone No .................. Nome of Contractor~~.~..~.' ................... Address ~~..i.~!..t~.. Phone Nc~..Y...-..(.~...' PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether ex~st~ng or proposed, and indicate all set-back d~mens~ons fro property hnes. Give street and block numbers or description according to deed, and shaw street names and ind~ca whether interior or corner lot. STATE OF NEW YORK, ~ c e COUNTY/OF ............ .,~¢;.....~ ........ / °'°' (Name of individual~ning~plicatian).~ above named. He is the.. ~~. ~.~...~~ .............................................................................. (Contractor, agent, corporate officer, etc ) of said owner or owners, and is duly authorized ~o perform or have performed the said work and to make and fi th~s application; that all statements contained ~n this application are true to the best of his knowledge and behe and that the work will be performed in the manner set forth ~n the apphcation filed therewith. Sworntobeforemethis~~.G, dayof.Z(/.:.~..~.~ .............. 19.~.~ ~~f ( .' Iz'_ ~~ /~ ' , .......... ......... , .... ..................... .................... Nota~ Public~~2~~ County (Sion~ture of ~pplicont)