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Home My WebLink About2311-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..t~./B..~,]z:,l_~t..]R~a~: .................................. Street Mop No...~ .......... Block No. ~ ............ Lot No..~'t~,~. ........ ~I~'e.~.~...N.~.Y., ..................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................................ }~aP~.....~, 19..6J~ pursuant to which Building Permit No ...... 2.~.'I~LZ dated .................................. ..~..~'.~....]-~, 19.~.., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ..... -~ -i.~a.t e...o~e...$a~.~.y.. ~we:!. ~.ing ........................................................................................... The certificate is issued to ....~Fa~.~.~.S..?~.e.~a~l~l ................. (~I~G~O ............................................. (owner, lessee or tenant) of the aforesaid building. H.D.Approva~ June 19, 196W FORM NO. ~ 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.° 2311 Z Date ................... J~at'OJt'""l'J~ ................... , 19..-6b~ Permission is hereby granted to: .................. ~h~r4.e:tw..l;;T; .............................. to .~ f..].~l., aec.. erie.-.4', wm'J...~ :/' · .d ~e.~ ~ 4_tt~- .................................................................................... at premises located at ...W/~.....Ji~;J..1, B...R(~a.d .................................................................................... .................................................. J~ixt~l,~...lg,~.o .................................................................................. pursuant to application dated , ........................ J/~l~h' ....... ~.~' ............ J9.~j;.., and approved by the Building Inspector Fee $....'l.O-e ~)~ ........ TO ~IOM IT MAY CONCERN: SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Building Permit No. The sewage disposal facilities for a structure located at · heed 10c~ation)--' have been inspected by this Department and found to be satisfactory, District Engineer FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ..... ~.~:2.. ........... '~ . ~/) ? Approved ~ ~ 19 ........ Permit ~'~o ................................. D'sapproved a/c .~~~ (Bull Application No. ~ [ / APPLICATION FOR BUILDING PERMIT Date ............... ....... .... 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 drown on the diagram which is port 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 ovoilable 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 hove 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. ..... ......... ........ ......... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ......................................................................................................................... Name of owner of premises ...... ,..,......{r/J/...~..~..4-.~ ....... :............,~..t¢.......,......,.(-/~;1~.~.¥.¥~.../. ................................................... If opplicantj~ ~ cor~grote, signature of duly outh6rized officer. ................... ~.~ ....... ~ ....................................... (Name and title of corporate officer) Location of land on which proposed work will be done. Map No:~~....~.~of 1. No: Street and Number .~/~....~.~;~ Municipality ": ......... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ ~.'-"[l ........................... .~. ................................................................................... b. Intended use and occupancy ...... ~.~.f.~.~d....~4~ ................................................................... 3. Nature of work (check which applicable): New Building ..... ,6.. .......... Addition .................. Alteration ................ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Estimjated Cost ...~../.,.i.~.,...~'..~....~. ................................. Fee ........................................................................................ i (to be paid on filing this application) 5. If dw,'e ing, number of dwelling units ........ ~..,4~.....Number of dwelling units on each floor .......................... If ga"age, number of cars ..............~..~ .......................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front .......................... Rear .......................... Depth ......................... Height ............................ Number of Stories ............................................................................................................ Dimensions of same structure with alterations or additions: Front ................................ Rear .............................. Dept,h .............................. Height ............................... Number of Stories ........................................ 8. Dime'nsions of entire new construction: Front ........ ,~..)~....' ......... Rear ....~..~.. ................. Depth~..~...~...'.'..X..~...~' Height ............................ Number of Stories ..~,~..'~ ......... 9. Size of lot: Front ........... /...~..~..L ..... Rear ........ /..~.~.~..~ .......... Depth ...J..Jf?...~...( ................ 10. Date. of Purchase ........................................................ Name of Former Owner ] 1. 7one or use district in which premises ore situated ............................................... ]2. Doesl proposed construction violate any zoning law, ordinance or regulation;~ ...................................... 13. Namie of Owner of premises ..~.....~.~.~..~.~.~.~..Address,~..~....~..4~r..~.~.~.Phone No.~.'......~.....Z> Nam'e of Architect ...................................................... Address ............................................ Phone No .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fro property lir~es. Give street and block numbers or description according to deed, and show street names and indico whether interior or corner lot. STATE OF,NEW ¥OR~K/, COUNTY 9F s.s. .................... ~.~,~t.~. .....................................being duly sworn, deposes end says that ho is tho ~pplicr (~ame of individual signing 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 th~s appl~cghon that all statements contained in this application are true to the best of his knowledge and and that t~e work will be performed in the manner set forth in the application filed therewith. Sworn to b~re ~e this J J Notary Public, ...~l~~~:~/~ (Signature of applicant)