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Home My WebLink About2622-zFOR~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIFS that the building located at ....~/~..~..[~t~ ..................................... Street BaT. fiaven @ Southo,l~, ~, conforms substanhaJJy to the Application for Bu,Jding' Perm,t heretofore filed ir~ this office dated .................................... D~9~.e~ ....... ~-3 19..(~j~. pursuant to which Building Permit No...26~,~,..~; doted ........................ l~.~J~).~.....~J~..., 19...~., was issued, and conforms to all of the requirements of the aforesaid building,r of the applicable provisions of the law. The occupancy for W. hich this certificate is issued is ........ ..... ~tv~t~ .one...C~%~... dw. ellin~ ............................ : ..................................... 1"? ................ The certificote is issued to ..... .~'[~I.811t.,W~J.~.8 ..................... o.~rtl~.l~.~.~ll.~-'lrlO~'. ......... i", .............. (owner, tessee or tenant)~ .......................... ..... , ............ [, ....... TOWN OF $OUTHOLD 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? 2622 z Date ........... .[~llt~ ....... .,~ .......................... , 19.(~.,.. Permission is hereby granted to: I/a...~e-~:]:,t ....... A:/',~...t~e~ ..... t~A'ewr. ..................... to ..l~a_¢.l~l.,.ne,a- ene..£~a~.~:~..~m.l:~.L~ ..................................................................................... at premises located at ..][,,~.'~..6..,.,1~,,~r..~'~'~ .................................................................................. ...................................... ~....~n..Iam~ .......... 8eu.t~o:~6 ............................................................ pursuant to application dated .................................. :D~ ....... ;~ ......19~...., and approved by the Building Inspector Fee $~l~J(~lO. ........... S-9 SUFFOLK COUNTY DEPART~NT OF HEALTH Bldg. Permit No. TO W~OM IT MAY CONCERN: The sewage disposal facilities for a str~cture located at (Give deed location) have been inspected by this Department and found to be satisfactory. " ~istrict Engineer ..... T TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ::~ ~ ~ ? Approved ........................................ , 19 ........ Permit No ............................ ; .... Disapproved a/c .~.,~ // ................................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin, Inspector. b Plot plan showing Iocat,on of lot and of buildings on premises, relationship to adioinmg 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 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. Suck 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 Buffding 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 Regular,ohs, for the construction of buildings, odd,tions or alterations, or for removal or demolition, os herein described. The opphcant agrees to comply with all applicable laws, ordinances, building code and regulations. .............. ....................................... (Signature of applicant, or name, if a corporation} .......... .............................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Builder Name of owner of premises ....... [~'.~..~....~.~.~..~.~. ...................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Nome and t~tle of corporate officer) 1. Location af land on which proposed work will be done. Map No' .~...~.~....~.~..e.~ ...................... ~_bt No: Street and Number ~t~ T,~--~e~ I~o~1~o].~ . .... ................................... .............. j ............................................................. 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................... b. Intended use and occupancy ......... .~.~.'Ir..?..~..~..~....~...l~....]:..~.~..Y~ ................................................................................. ,~. Nature of work (check which applicable)' New Budding ..... .~. ........... Add~hon .................. Alteration ................ Repair .................... Removal .................... Demolmon ................... Other Work (Describe) .................................... 4. Estimated Cost $14,000e00 ~oo $10o00 (to be paid on filing th~s application) .5. If dwelhng, number of dwelling units ......... ~ ................. Number of dwelling umts on each floor .......................... If garage, number of cars .......... .O...~.~ ........................................................................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D~mensions of ex,sting structures, ~f any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................. D~mens~ons of same structure with alterahons or additions' Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stones ........................................ 8. Dimens,ons of entire new construction Front ..... $...~.! ................. Rear t]2t Depth 2,~: t Height .......... ..~..~..! ........... Number of Stories ......... ..]:. ................ 9. Size of lot: Front ........]:.0...0. .............. Rear ........ .]:.0...0. ............. Depth .....~.~.0.. ................... 10. Date of Purchase ..... ~...u,.~.~fl.t~.~..~..g..~..b. ...................... Name of Former Owner ..... ~.]:..]....~....~.....~.~.]r..~ .................. 11 Zone or use district in which premises are situated ......... ..~.f~.@..]:~.~.~..]:. ........................................................... 12. Does proposed construchon violate any zoning law, ordinance or regulahon? ........ ~..O. ....................................... ' Fre~ Freer Al1Bay Haven, $outhO~one No. S05-329~ 13. Name of Owner of premises ........................................ naaress .............................................................. Name of Architect ...................................................... Address ............................................ Phone No ................... william Wells ... Bay Haven, Bouthol~ B05-274~ Name of Contractor .... :: .............................................. ~aaress ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fron property hnes Give street and block numbers or descnpt~on according to deed, and show street names and indicat. whether interior or corner lot. STATE OF NEW YORK COUNTY .OF .... ~.~.t'.]~'~;l,~. .......... ~ S.S._ William Wells ....................................................... bmng duly sworn, deposes and says that he is the applicon ................ i~ame of individual signing .a~D~lication) ' above named. He is the b~l£(~el~ (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fil~ th~s apphcahon; that all statements contained m this application are true to the best of his knowledge and belief and that the work will be performed in the manner set forth ,n the apphcahon filed therewith. Sworn to before me this ....... .~...6..r.~ ......... day 9~.~..~.c29...m]g.~.l~. ...................... , 19..$~.. / / '~/ ' /,? ~/~, '. .......... ...................................... Noto Pub,,c, , (S,gnature of app,,can,) l'qo. ~-g~)~75 Suffolk ~,mmi~ion Expires ~'eh ;;~0.