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Home My WebLink About2344-zFOI~i~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~...1.022- ........... Date ...................... ~Re.l~l:.emb. er......~L~.., 19.~.~... THIS CERTIFIES that the building located at ........ g~.l.~.%~..~_~X.$~%~,~'i ..................... Street Map No..(J~,g~Yl ......... Block No .......... ~ ........Lot No. ~ ......... lBOt~t~O.].¢] ................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................................ ~Z'.~L.....9. ...... , 19..(~.. pursuant to which Building Permit No...~...~...~.~... dated ............................ '&'~'Z'.~'~"..'9 ........ , 196)4...., 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 ........ .... ~.~$vate...o~e...f. am~,l:~..d~e..l.~n~ ............................................................................................ The certificate is issued ~6,~Z;~..~'~.~.~:~. ........................ (,~-~ .............................................. (owner, lessee or tenant) of the aforesaid building. Building Inspeltor FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUiLDiNG PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETI~ON OF THE WORK AUTHORIZED) 2344 z Pert~ission is hereby granted to: at premises located at ....{)al~tli~l~..~'e...~ ........................................................... ......~ ................... pursuant to o~plication dated ..... ,......;....; ......... ~P$'~, ....... .~ ............. 19(~1~..., :~3nd cpproved by the Buildiog Inspector Fee $.~, 0.0..; .......... ~ ..... 13uTIdin~- Inspecfor; ~ FOI~M ~0, 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ......................................... 19 ........ Pormit No ................................. Disopproved *lc .................................................... ................................................................ ........................ .............................. APPLICATION FOR BUILDING PERMIT Dote ................................. , 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 premises, relationship to adjoining premises or public streets or areas, and giving a detailed description 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 o Building Permit to the applicant. Such permit shah 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end 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, ordin,~l, nces, buildizrjr~ code and/~egulatiol~s. ........ · .,. ......... ............................. (S~g~ature o?'o)~pli~i~nt, or nan,'e, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................ '.,.i ...................................................................................................................................... Name of owner of premises ~.~:.~ .. .~,~.~.~.~? ..... . .......................................................................... (Name and title of corporate officer) 1, Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number .~...8./:..x..~.I~.~.../:.M..,..~/,J..~F..:'.....~.L~ ...... ..~..c..?..U.~.~.~.O.~,,.~?.......~.:...--~....~ ................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ,~.~.~.Z..~.~.~ ............................................................................................................... b. Intended use and occupancy . . ..O..~.t~....~...~..~ ..... .~-}.g..~.~. .......... ~,).~/~ ...... 3. Nature of work (check which applicable): New Building .................. Addition ......./...% ...... Alteration .............. Repair .............. ~¢.. Removal .................... Demolition .................... Other Work (Describe) .................................. 4. Estimated CostC~.,,.¢~....~...~..,~,~..~. .................................. Fee ...................................................................................... (to be paid on filing this' application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........................ If garage, 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 ....~..~...~....~z..... Rear .,'~.~....~'.., .~.'.~'. ...... Depth .~ .~....~ .... Height ..Z~......./~...~.¢, ..... Number of Stories ........./ ............................................................................................... Dimensions of same structure with alterations or additions: Front ~ ~,~'~7 Rear Depth .~..~.....~...~.r.. .......... Height .../..~...~., ./.7.4 ............ Number of Stories ..... ./.. ................................ 8. Dimensions of entire new construction: Front ..... ~.~.../~'....7'7. r. ........ Rear ...... /.~.....~...~..~ .... Depth .../.'...~.....'.~....~,-..., o ../E..7 / Height ../'. ....................... Number of Stories ............................ 9. Size of lot: Front ,/,.~.~, ,~..~...,,,~, .,/~,~ Rear ...,(r¢.?..Z .~,..,¢~.,..,~.,./..'~. Depth ..,/,,,~,,,~,.~,,,..~.~., ,~,~¢, ....... 10. Date of Purchase ,,*~,,,,,,...~,,,U,,,,~,!,.~.,....Z',,~,,,~,,,.,,~, ........ Name of Former Owner ~,~,~/'¢ .... ,~. ~,,,~r~' /4~- ' '"~":'~:'~J";~;~'~;~'~ ........... l 1. Zone or use district in which premises;d~e ~itunt~rl~'~ o~4/~,~o~ /~t~-, ~T', ~-~'~ 6/~,~/¢ 12. Does proposed construction violate ~f~y zoning law, ordinance or regulation? ...... ..~.,..O.. ..................... ~ .............. 13. Name of Owner of premises4/E.~..C.~...X~.~..~'.Z,/~.~..~..~,9.'.rA~dress !-.o.~.~¢....~..../J.g..~.n.~.?..~..C./C~none No?'.:..~...7....~...~ Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor .................................................... Address ............................................ Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whethe¥ 'existing or proposed, and indicate oil set-back dimensions fr, property lines. Give street and block numbers or description according to deed, and show street names and indi, whether interior or corner lot. \,q ~3 STATF OF NEW YJD[~I(., COUNTY OF .%u...~...~....o..k.~x ........ / S.S. ..~..?../.U~t /t//~ZZ/~I.~.~.~.~0 .%~..'~, be ng duly sworn, deposes and says that he is the app[ic ............... '~'i~'~i'~b ~'ppli~t'ion) ............... 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 f this opplic0tion; that all statements contained in this application are true to the best of his knowledge and beli~ and that the work will be performed in, the manner set forth in,the opplica~;ion filed therewith. Sworn to befor~ me this .............. ............ ,, --× ', .......................... Notary Public, ..~~,..~°~N..'.,.,~../.Z.~.C/~upt~v //% / ¢x~Si{l'na~re of applicant)