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Home My WebLink About2406-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..Z.,22~0 ............ Date ......................... 0O.tO.~e~.....1B....., 19.6.~,.. THIS CERTIFIES that the building located at ..... .~a.~..¥.~.ew..D~[.~.e ............................... Street M~J~.i..~.?.'..~.?....~...~..~...~B~o~k No ............ .~X ......Lot No. t.20.&...1~.1 ....... conforms substantially to the Application for Building Permit heretofore filed in this office doted ............................ ~: ......... ,O~ ................ , 19.~.~.. pursuant to which Building Permit No..~06..~ dated ............................ ~]a~....~.6 ..........., 19..~.~.., was issued, and conforms to oil of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ........ ....... ~tv~tw" on~ ' 'fm~i'~'..d~e'Z.~it~g .......................................................................................... The certificate is issued to ...(]~l~r...~.~...]~O.~ ......................... ~e~'. ............................................ (owner, lessee or tenant) of the aforesaid building. H.D. Approval Oct. 1~196~ by R. Villa .......... ........ ................ Building Inspector FORM 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? 2406 Z Permission is hereby granted to: · J~ ..r,~e~ · ....~.¢ ....~e.ley:..l~m,m ...... to ..... ]~tid..ne~..o~e..$am~l.y..~l~ett, t. ng .................................................................................. ct premises located at ..~O.tS,..12O..&..;J~.....(J~lLF4JaJjeH..J~..~lltet~ ................................. .......................................... ~a~...~.s. ~. ~;)~ .......... F~mt ...Na~oa ....................................................... pursuant to application dated ............................... ~¥.....~,6 ............. 19...(3~, and approved by the Building Inspector Fee $...~.~,~..(;~ ......... Building InSpector s-9 SUFFOLK COD~TT DEPAE~MENT OF HEALTH Date~ mdg. ~e~t .o. ~._~ ?~ TO WHOM 1T MAY CONCERN: The sewage disposal facilities for a structure located at ~ .~(Give deed location) '~ have been inspected y this Department and fouad to be satisfactory~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Exom,ned ......... Approved ........................... ~ ......... ~ 1~ ........ ~e~t ~o .............................. Disopprov~ a/c ........................ ......................... ........................ APPLICATION FOR BUILDING FERMIT 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 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 a,pproval of this application, the Building Inspector will issue o 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MA,DE 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, alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. East ~arion (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ..~...~....?....~. ...... . ..~..........~...../~....~.......f~....~.. .................................................... i ..................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ............................. Lot No.: /...~.. .... /....~.../' Street and Number .~..?.~..~'../.;~...~.........,~....~../'..U..¢. ........ .~.~....~..~'.....~.....,~...~...~./.~4']. .......... "..i ...... ....................... Municipality It' State existing use and occupancy of premises and intended use and occupancy of proposed construction. a. Existing use and occupancy ..... .~....~.~...~...(..?...PI...~. .................................................................................. b. Intended use and occupancy ...... l~...~...~..I...~....~....~.:e....~.. .......................................................................................... 3. Nature of work (check which applicable): New Building ~ Addition .................. Alteration Repa r .................. Remova! .................. Demolition .................. Other Work (Describe) .................. 4, Estimated Cost J ~'J, oecTM,~ ........... ,' ................................................. 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 ............................ Rear ............................ Depth .............................. Height ............................Number of Stories Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ................................Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... ..~..r~ .............. Rear ~ ~ ................ Depth ....~.......~:.. ................ Height ...~.?~. ................... Number of Stories ...... ~ ............... 9. Size of at: FJont Rear "~_ ~ i c2,'e ............................................ ~p[n ................ ~,~.....l~..~p- ~- C~ ' 10. Date of Purchase ~'.~ .~ ,. r ...................................................... r~a,me of Former Owner ...... · '~'{ '~'~ ~' ............. : ...... .'~.'~ ~. ~.~ m: ~.~?,'~l' ~ ] 1. ~-one or use a~strlct m which premises are situated ................................................. ' ..................... ~_J 12. Does proposed construction violate any zoning !aw, ordinance or reaulotion;) 13. Name of Owner of premises ..~..../...1~...£..~..~..~. Address ~..,m..~.~..~r'/'~..~ Phone N~' ...... '~'-']~'~'J~ Name of Architect ~..¢~..~?...m....~_?~,~.~.. ................. Address ....~..~..~..~..~Z.~..¢../~ ................... Phone No ................... Nome of Contractor .i.~/Z7~.£ /~.,~ ££~ Address J~.~'-~- /..l'J~l'Y~l? Phone No .................. PLOT DIAGRAM Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. (0. o · STATE ~F~NE~--YOP,~J~ , ~ ) S S COU NTY~~..k...),/~_~, ~, . ............. ~=,Z,~'"'~ *~:...~.....~.--~: ................ being duly sworn, deposes and says that he is the applicant [ (No~e of individual signinmapplicntb,) above n~ 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 thi application; that all statements contained in this application are true to the best of his knowledge and belief; an~ that the work will be performed in the manner set forth in t~pp cation filed th~ith. Sworn to~efo~e~/~ me this ~ ~~- 7~'~_~ .............. ~....~ day of ................... ~.~....., 19...'.~/~ ....... ' ................. j~,ff.~. ~oumy ~/ (Signature of applicant) "' NOTARY PUBLK~'c-or r~,,.~ Yor~ NO, 52-323312~ 8ulfoik Count Term Expires March 30. 19 ~ g