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Home My WebLink About2613-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..il/Fx..~mna.~u~e.~..~oa~ ................... Street Map No ..... ~ .......... Block No ......5r~X ......... Lot No. conforms substanhally to the Applicabon for Building Permit heretofore filed in th~s office dated ....................................... ~eae~tbe~..~R.., 19...(~.~. pursuant to which Bumlding Permit No..~,~.~.~.....Z.. doted ............................ .~l~.Cte~tb.i~tl~..~L~, 19..6.~ , wes ~ssued, and conforms to oll of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ .~.~,~.¢.e...o.r~.../*~fl, l.~*....q~ .z.~l ~..r~g, ............................................................................................ The certificate is issued to .... .~..;~]-..~.~..B.~....~.-,....~..~.]-..~.$~.~.~. ....... .0.:..~...e.~ ............................................... (owner, lessee or tenant) of the aforesaid building Building Inspector FOF, J~ NO. 2 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? 2613 z Permission is hereby granted to: ~..Z~bo~o~stc_~ ..... Aj~ ..... I~....Milltam J Hilliard ............. F& sher..s...YslarAd ................................. to ..... ]B~.:~..l~l..naw...c~ne..f,~,.!l,~...dwe, l~ ................................................................................ at premises located at ..... W/~.....~l~,.~,.~,~.~..,~l[~ ........................................................................... .......................................................... ~.~Jt~..~... X~ 1.~ ~.. ~.~ ~ ..................................................... pursuant to apphcation dated ........................................ ]~'.'"'"3'" 19~.., and approved by the Building Inspector Fee $..~...0.:.,..(~,. ........... .... z.~u~.u..,~...~ ......... .J......;: ....... , ....................... Building Inspector ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ............................ ,19 ........ Perm,t No Disapproved a/c .................... .~.~r~. ................... :~ .~¢~-~.. ......................... ....... ...................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a This apphcahon must be completely filled in by typewriter or ~n ~nk and submitted m duphcate to the Buildm Inspector. b Plot plan showing location of lot and of buddings on premises, relationship to adloming premises or pubhc streets c areas, and gwmg o detailed descnptton of layout of property must be drawn on the diagram which is part of th~s opplicotlo~ c The work covered by th~s application may not be commenced before issuance of Building Permit d Upon approval of th~s apDhcation, the Building Inspector wdl ~ssue a Building Permit to the applicant. Sucl permit shall be kept on the premises avadable for inspection throughout the progress of the work e No building shall be occupied or used I~ ~whole or m pa rt for any purc~bse whatever until a Certificate of Occupanc shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Or&nances o Regulations, for the construction of buildings, ad&tions or alterations, or for removal or demoht~on, as hereto described The apphcant, agrees to comply w~th all applicable laws, ordinances and regulations (Address of opphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncmn, plumber or builder ....................... . ........................................................................................................ No, me of owner of prem.ses .... .~.~./:' ..... ~.. ~./?'~ .~7.../4...~..... ~ .... ~/ ..L..~./.'.a....~.. ~, ........................ applicant ~s a corporate; signature of c;[uly authorized officer (Name and titltof corporate officer) Locobon of land on which proposed work wdl be done Mop No ......................... Lot No' . ............ Street and Number .... ~..~....~.."YL ./~-...~.~ . .~...,.~' ..~.. ..... ].~ ~c~...~. ............................................... Mumclpality State ex~stmg use and occupa.ncy of premises and ~ntended use and accupancy af praoosed canstruct~on a Emsting use and 6ccupancy ....................................................................... b .tended use a.d occupancy ...... r-L F ? 3 Nature of work (check which apphcable) New Budding ~/.tl~/~/. Addmon ... Alteration .... Repmr ......... Removal ......... Demolmon .... Other Work (Descnbe) ............... 4 Est,mated Cost .......... ~.~ ~ ~'o ~.~. .... Fee / ~.,.. ~. (to be pa~d on fihng th~s apphcahon) 5 If dwelhng, number of dwelling units . il . ..Number of dwelling umts on each floor .i~ If garage, number of cars ................................................................... 6 If bus~ness, commercial or m~xed occupancy, spec~ fy nature and extent of each type of use ............ 7 D~mens,ons of ex~st,ng structures, ,f any Front . '~ .~ ~.~ '~ Rear ../...~../- ¢ ¢~ Depth ~//~/'~ ~ Ii Hmght ............ Number of Stones I ....................... Dimensions of same structure w~th alterahons or addmons 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 .... ~.~.-...~ * .... Rear ,/ ~'-~ ¢¢f Depth ~..?..r: ,, ,, 10 Date of Purchase ./~ ~. ./¢.~ ~. .. Name of Former ~ner~.~,.. ~ _ -- -- .¢~'~'k¢~ ......... 11 Zone or use distr,ct ,n wh,ch premises are s~tuated ..... ~ ~.~.$..~t./.' ......... 12 Does proposed construction wolate any zomng law, ordinance or regulat~on~ ..... ~..~. ........................ 13 Name of ~ner of premises ~1~ ~.S~.~ ~.¢~n~ No Name of Architect ................... Address ............................. Phone No ....... Name of Contractor ............................. Address ................................. Phone No .................. PLOT DIAGRAM Locate clearly and dlshnctly all buildings, whether exishng or proposed, and md~cate all set-back d~mens~ons fro. property hnes Gwe street and block numbers or descnphon according to deed, and show street names and ind~ca whether interior or corner lot STATE OF NEW YORK, ) S S COUNTY OF ........... /.. )1. .................................... ..~ , ... being duly sworn, deposes and says that he ~s the applica above named/'l~e ~s the (~' ..... ~."~"~"-/' j2 ~"C 7~ ~ (Contractor, ag~t;'c~'~'~'~f~','~;~'~') ........................... of sa~d owner or owners, and is duly authorized to perform or have performed the smd work and to make and f ~s apphcation, that all statements contained m th~s apphcat~on are true to the best of h~s knowledge and beh, and that the work w~ll be performed m the manner set foffh ~n t~e appl~cahon filed therewith Sworn to before me this ................... day of .... ].]~]......~ ..... ~..]:~:~..~.:. ~..~:. 19.