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Home My WebLink About2621-zTOWN OF SOUTHOLD BUILDING DEFART/~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .... .2~...22~- ......... Dote ........... QC~.c~I~.. ~11 ................. , 19...~5. THIS CERTIFIES that the budding located at . .E&t;r[! .~r..~tt:5?c~ .................. Street conforms substantially to the Apphcat~on for Budding Permit heretofore filed m th~s office dated .......................... De~t¥~e~.,,2~. ....... , Icj54 .... pursuant to which Building Permit No..~.~,~,,,,~, dated .............. ,Oecellt]:;~l:..~8 .... , 19..!641, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate ~s issued ~s ....... ............................... e~l,~¢[~..~.. ~7~1[~¢~ ......................................................................... The certificate is ~ssued to ....... ~n~..Q~[~-4,~:J. ....................................................................... (owner, lessee or tenant) of the aforesaid buddmg Building Inspector FOI~M 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? 2621 z Permission is hereby granted to: to ~1.~..e~..nd~l. ocs..on..a~..ez.~t~a~ .~tvel.:L.~,r~ ........................................................ ~t premmes located at .,~t~.J~...~t,~e~*.il. 8.~ .~t~.-~'..~[~[~l~ ...................................... ............................. ~.l~.....P~;L~r~l;e..J~a6~ ..... ~t.t4Ltuek~ ..... ~..Z. ............................................ pursuant to apphcation dated ..................... JD4t~e~l~be~.....~.~ ........... ]~.., and approved by the Building Inspector Fee $5. Q0 .............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................ D~sapproved a/c ....................... ~.~..~ ............... i':: .................. ;~' .............. ~':~ .... .................... ...................................... (Building In~ector) Application No..'..~....~...~.../.. ........ APPLICATION FOR BUILDING PERi, IT Date ..... :~:.....~...( ........................... , ,,~.¥: .... INSTRUCTIONS a Th~s application 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 descnption of layout of propertymust be drawn on the diagram which is part of this applicatior c. The work covered by this apphcation may not be commenced before ~ssuance of Building Permit. d. Upon approval of this application, the Building Inspector w, II issue a Building Permit to the applicant. Sud 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 m pa rt for any purpose whatever until 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 Building Permit pursuant to th. Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. ........... .......................... (Signature of applicant, or name, if a corporation) ............................... i;~'~/;;;f~'-g'f"g~'~i',~;;~;~) ........................... State whether applicant is owner, lessee, agent, architect, engtneer, general contractor, electrician, plumber or builder ....................... ~ ............ ~....C,..~ ......................................................................................................................... Name of owner of premises .... ~~-...~~:.....: ..... 2.(.~...~..-.~.'.,...L~....~.: .................. If apphcant ~s a corporate, signature of duly authorized officer. .................... i~i~;;"~';~'~"fi~i;';F~;;f;~;~;';~'fi~;~'~' ................... \.~, o~'/~-~ ~-I ~ ~ C~ ~ ' rk ' e a ~~ /~' ~ ~T~ 1, Location of land on which proposed wa will b done. M p No' . ........................... ~.~.. Lot No: ................... ~.~et ~,,~,~ ...... Z~:~...~...~....~Z~...C.C~'~...~..~.~~ ................... Municipali~ 2.State existing use and ~cupancy of.premises and intended use and occupancy of proposed construction: o Existin~ use .nd occup,ncy ................................................................................................................................. ~ ,~ ~ o~ o~...~~....~....~~ .............................................................. 3. Nature of work (check which apphcable): New Budding .................. Addition ....~. ......... Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Estimated Cost ........... ].....~...f..Ck. .................................. Fee ........... ,.~...;...C,....'~.. ............................................................. (to be paid on filing th~s apphcat~on) 5. If dwelling, number of dwelling un,ts ............................ Number of dwelling umts on each floor .......................... If garage, number of cars ......................................................................................................................................... 6. If business, commerc~a~ or mixed occupancy, specify nature and extent of each type of use .............................. .... 3....9.. ........... 7. Dimensions of ex~stmg structures, ff any: Front ...... ~ ............Rear Depth ..,.,~..~ ................ He,ght ...... ./..~.../. ............ Number of Stories ......... f.~ ................................................................................... D~mens~ons of same structure w~th alterations or additions: Front ......... ..~...~ .............. Rear ...... ~...~. ................ Depth .......~..~ ................ Height ....../...~... ............... Number of Star,es ...... £~.~..T. ................ 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth .......................... Height ............................ Number of Stories ............................ 9. Size of lot. Front ........~...~.,.~/ ....... Rear ...~./../.' ...... ~. ......... Depth ...../..~...~.....~.. ........ 10. Date of Purchase ....... -../..~.~.....~..~, ............................. Narn~e of Former Owner ...~c~....(.~~~;~. ..... 11. Zone or use district ,n which prem,ses are situated ..... ~.~.-Z../a..,...~.....u...~;.~...~ .......... .~......O.. ......................... --(j.. 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ ~....t¢:C.....': ................................ 13. Name of Owner of prem,ses ~~:...~adress ..~.?...,w~.~...~ ....... ~.., .... Phone No ................... Name of Architect ..... ~. ............. ~ ................................. Address ............................................ Phone No ................... Name of Contractor .J~ ~..t .....Phone No. .~ ............. Address ..................... PLOT DIAGRAM Locate clearly and d~stmctly all buildings, whether ex~stmg or proposed, and ind,cate all set-back d,mens~ons fro, property hnes Gwe street and block numbers or descnpt,on according to deed, and show street names and in&cat whether interior or corner lot. ??,¢ STATE OF NEW YORK, ~ ¢ S COUNTY OF ............................... I o . /~'~/ ~-..~ __ ............ ~ ..... ~.~.~.: ........................ being duly sworn, deposes and says that he ,s the applican (Name of individual s~gr~i9g apph'cation) above named. He is the ............ ~.....~---¢x..' .............................................................................................. (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 fil this apphcatlon; that all statements contained in this application ore true to the best of his knowledge and belie~ and that the work wdl be performed in the manner set forth in the application filed therewith. Sworn to~b, efore me this ~Z~ -- --~ '' ................~/~: ....... day of .... ..~...~-..c~,..- · ...................... -' ...... C: , , .... .... ...... · ................ Notary Pubhc, .~...J...') ............ -.~..~ ...... (. .............. '~t ...... (. e~:~ ~ooi~gnature of appl,cant) / J Term Expires ~rch ~0, 19_{.._s-