The URL can be used to link to this page

Home My WebLink About2612-zFOR~I NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ~...~.~.~,.i ............. Date .................... J~%/,li.t,....~,(~ ........... , 19~... h THIS C,ERTIFIES that the building located at .J~l~..~d..~z..Wl&~,a~td,..l~ .................. Street Map No..~1~ ........... Block No .........~ ..... Lot No. ~ ......... ~Ott,~J~Cl~d1 ...... N,~, ............... conforms sub~tanhally to the Application for Building Permit heretofore filed in this office dated / ,,' ............ J'. ........ 't ................... J~Jap.t,....26 ..., 19 ~.~.. pursuant to which Budding Permit No .... ~(:~j,~...4~ dated ..i ...... ' .......................... T~....~.~ .., 19~11~ .... was ~ssued, and conforms to all of the requirements of th~ aplSlicable provisions of the law. The occupancy for which th~s certificate ~s issued is ........ ....... ~i.. l~i~a ~ a..o~e.. ~amil~.. ~lwal~l&l~ ................................................................................. The ce, ftificate is issued to ..Ci~'.l.e,~..Esm~a~ .&..W.l,f..e ........................ 0~1~1~ ......................... (owner, lessee or tenant) of the.'oforesmd building NOTE~ Approv~ by Bd/Appeals ~uua,ng ~nspector ~ FORM NO. 2 TOWlq OF SOUTHOLD BUILDllqG DEPART,MElqT TOWN CLERK'S OFFICE $OUTHOLD, lq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 2612 z Permission is hereby granted to: pursuant to application dated ..................... ~.~, .......~! .................. 19..~1~., and approved by the Budd,ng Inspector Fee $~..:...0~... .............. Building Inspector FO~M/~0. I TOWN OF SOUTHOLD ~BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No....~.....~...../..~... ...... APPLICATION FOR BUILDING PERMIT September 26 D- 19...~...~. ..... ate ........................... ...., ........................... , 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 a Building Permit pUrsuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction 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. (Signature of applicant,~ or name, if a corporation) Southold · (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .......................................... g.o.~,~ a,~ .~.m:....-... ~g e~, ............................................................................................................ Nome of owner of premises ......Ci~r.l~s.,Ess~um**&..~/~e .................... : ................ ~ ...................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ........... ~ ....................... Lot No::...~ .......... Street and Number .....~..e...D~...l~.~.~.c]...~..W.e.~,ll.c],..~g.~l,a ........ ~J.~.lJ.~]~,~ ......................... ~ ........... i~. ................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed cOnstruction: o. Existing use and occupancy ..... ,~¥~'1~'1~ .......................................................................................................... b. Intended use and occupancy ........................./....J~.(]l,.~.~.~.~.~ ............................................................................... 3. Nature of work (check which New Building .................. Addiff~K ....... .~... Alteration ....... 7,~... Repair .................... Removal .................... Demolition .................... Other Wor~ (Describe) ...................................... 4. Estimated Cost ....... le.~0.q .................................. "....Fee ...; ....... ~., ....................................... .................................... (to be paid on filing this application) S. If dwelling, number of dwelling units ....~1.t~ .........:;....,..Number of c~welling units on each floor ....... ..................... if garage, number of cars ......................................................................................................... ................................... 6. If business, commercial or mixed occupancy, specify nature and extent of ecch type of use ................................ 7. Dimensions of existing structures, if any: Front ....~0..~/.)~ ....... Rear .......................... Depth ....~.~, .................. Height ............................ Number of Stories .'....D, IJIP**..; ............................. ~ ........... ~...:'....~..:**..~ ................................... Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height ............................... Number of Stories ........................................ 8. Dimensions of entire new construction: Front ........ 3,b~.. ....... ':...** Rear .1..~-..~ .................... Depth ......... 2.~. ............. Height ............................ Number of Stories .D//e. ................... 9. Size of lot: Front ....1.C)~ ................. Rear ............................ Depth ........... 1~3. ............. 10. Dote of Purchase ........................................................ Nome of Farmer Owner ........................................................ .itu_.e~ MA. dis*t; 1 1. Zone or use district in which premises are , u~ u ................................................................................................. 12.' Does pr~oposed construction violate any zoning law, ordinance or regulation? ........... 13. Name of Owner of premises ..~..~.li~l. lt~.; ............. AddresS ............................................ Phone No ..................... Nome of Architect ...................................................... Address ............................................. Phone No ..................... k Add Sol/thold ' Nome of Contractor D. lb'ec~erle resS ............................................ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW '~OI~,K ) COUNTY OF ..... .......... S.S. ............... Dnnal~..~.eae:tok...,.:..., .......... ~ ....... ,..being,duly sworn, depots and says that he is the applicant (Name of individual signing_ _ .__ _. #..-/~z ' ~apphcati°n) ~, . above named. He is the .............. ~.~.~J::a,~.'t;D.~....'...~gl~,ll:J~./~l~:'L~...~..~..~u,~/...~...,( .............................. (Co~tractor, agent,/gorl~ora~e officer, etc.~ of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicati~on are true to the best of his knowledge and belief; and that the work will be performed in the manner *s~t forth in,the aPl~Cation filed therewith. Sworn to before me this · . uu, n ~. o~ i n r Notary Pubhc~~:~....~~ ~J~l'i~,~st,to of aew ¥o.rk ,(S~,~g~ atu · of app cant) ~/ No. 52-0344963, Suffolk Coun'[y ~ ~., , Commission Expires March 30,