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Home My WebLink About2289-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No, ..Z...1.9..3.b,. ........... Date ........................... ~e~ ....... ~.2 ....... , 19...6.1%· THIS CERTIFIES that the building located at ...~O~ta~.,JLV~ ........................................ Street Mop No....,~7~ ........... Block No .......... .,.Y~...X.. ..... Lot No, ,,~ ....... F.i.sh~r.~,..~Bla~cl ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... Jan~a~'.y.....22...., 19..6.tl-.. pursuant to whiJh Building Permit No. dated ............................... J'arl., ........ ~..., 19...~.L}-., was issued, and conforms to oll of the requirements of the oppllcable provisions of the law. The occupancy for which this certificate is issued is ........ ................... .On~... £,~mi l¥,..d,~e,'L].ing....-... P.e,J~.~.~n~,g .e .................................................................... The zertificote is issued to ....U,,',~o~..C~.loe~ ...................................... D;~A~ .................................. (owner, lessee or teno~t) of the aforesoid building. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y; (THIS PERMIT MUST BE KEPT ON THEPREMISES UNTIL .FULL COMPLETION OF .THE WORK AUTHORIZED) 2289 Z Permission is hereby granted to: ........ ~..~,~h~..Z~:,....~,.:.....:~.......~ ........ uilding Inspector Fee $.1..~.0~ .......... Building Inspector FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. ~ ~ ~ ~. APPLICATION FOR BUILDING PERMIT Date ...... . .~.....~....~..0...~....~..~.. ?....t~ ............ , 19..~..~ INSTRUCTIONS o. 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 p remises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applica- tion. 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 applica.nt. 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICAT~ION IS HEREBY MADE to the Building Department for the, issuance of a Building Permit pursuant to the Building Zon~ Ordinance of the Town of Southold, Suffolk County, New/Y,/o;l¢, and other applicable Laws, Ordinances or Regulations for the construction of buildings, additions, alterations, o/~¢r] rerr~AJ or,/~olition, as herein described. The applicant agrees to comply with all applicable laws, ordinances~llf,~?Zg, ul/tic.~// (Signature of ap~ ~cc~, or name, if a corporation) (Address of applicant) Sta¢e whether applicant is owr~er, lessee, a~gent, architect, engineer, general contractor, electrician, pIumber or builder. ........ .l. . . . . : .t: .......................................................................................................................... Name of owner of premises ...:.~'.[.~:~....C.~.~.~.../. ................................................................................................. / If .applican,~Tcorp'ra~,si'na're of duly authorized officer. .............. ......................................... I (Name and t~e~ corporate officer) 1. Location of land on w~i~h pfoposed~wgrk ~11 be done. ~ap No.: ............ , .......... ~ ............... Lot No.: ........... Street and Number .~..~1~1.~.~..~.....~¢~...~'..~....~.~.~....~.~..(.I.~.. ................ 'Municipality " 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ..... I x~ .... Z..~. C..... ~. ~Z :~:...~.~........r; .... : ............. b. Intended use and occupancy ................................................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition ~ Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe) .................. 4. Estimated Cost ..... ~..~...~.~'.~..~...~.. ................................. Fee .............. ~.~..%~.,~.. ........................................................ (to be paid on filin~a this application) 5. If dwplling, number of dwelling units ......... l ...................... Number of dwelling units on each floor ........ ~ ........... If ga:,rage, number of cars ............ "--; ........................................................................................................................... 6. If bu.'siness, commercial or mixed occupe,ncy, specify nature .and extent of each type of use ................................ 7. Dimens OhS of exist ng structures, f any: Front .~.~..~ ........ Rear ..... ff...~..~ .... Depth..~.~..~. ~..~'~.,~ ~ Height ...... .......... Number of Stories ...... .......................................................................................... Ii... Dimensions of same,structure with alterations ,~r additions' Front .~..~..~.~, Rear .~...g/..~..~.., ~ Dept~ ~" f'/~>/~ Height [~:~ .~..~' Number of S~i'~ ...... ~.~.'.'i ............................ I'" 8. Dimensions of entire new construction: Front ......... ...~TT_T. .............. Rear .............................. Depth Heig t ............................. . Number of Stories .............................. 9. Size ~F lot: Front .............................. Rear .................................. Depth .............................. 10. Dare'of Purchase .......................................................... Na.m~ of Former Owner .................................................... 1 1. Zone or use district in which premises are situated ....... t~..~.-.~.',, .................................................... 12. Does proposed construction violate any zoning law, ordinance or reaulationV ..... '..~....~..... 13. Name. of Owner of premises ..~..~.(~.{¢.~......~..~..0...~... L Address .~..*~J..~..~...~i~.[.".~'.i'.'."~2'~"~'~.'~.~."..'.~.'ii Nam'e of Architect ..... ~.~ ....... ri.'-...~.~ ....... ..[. ......... ~.. Address ....... Phone No ............... Name of Contractor ...~..o.~.~ ..~...~.~..~l~.~...~. -.-I-"- Phone No. ~.~..~. ~' ~ ... Address ..................................... PLOT DIAGRAM LocaCe clearly end distinctly all buildings, whether existing or proposed, end indicate all set-back dimensions property lines. Give street and block numbers or description occording to deed, end show street names and whether interior or corner lot. STATE OF S.S. (,,1~ ............ being duly sworn, deposes and says that he is the (Name of fflcation) above named. He is the ~ (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 file application; that all statements contained in this application are true/~o the best of his J<nowledge and belief; that the Work will be performed in the manner set forth in the applicati!if~/~/led tli/er~wi/n. /// Sworn t,o, b'efore me thi~ IIII/ ~ /I I /I Notary Pu~lick~'~..w.~.~:,; ,'.:::.:::.:.. County ........... /(~/~"~" (~/~c~'~Z~'l~'ii'~'~;~')' .........................