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Home My WebLink About2762-zFON~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z..~,(~ ............. Date ................................. A~tS~.....~. THIS CERTIFIES that the building located at ....~.~.....(]~l~ri.t...l~illd~l, lg...~l~t~d ........... Street Map Nio ..... ~ ........... Block No ...... ~ .......... Lot No.z31~ ......... 5'OU~hOtd'j'""'li'~'~;~ ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................. I~ .......... ~ ............... , 19~.... pursuant to which Building Permit No. dated ........................ ~ ....... ~0. ............ , 19.6~..., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .......... PZ'.tvat~e .. erie...£aai~...d~el.lil~ ....................................................................................... The certificate is issued to ...ll~e~.l'..'Bt~kavieh ........... ', ............ ,aimed-..: ....... :.; .............................. towner, lessee or tenan~ of the aforesaid .building. a,D,Appz'ov~l Au~. l~t 196ff 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? 2762 z Date ................................... ~11~.....20 ........ , 196.~... Permission is hereby granted to: ~eo..~,a~ol~....,li~'¢....Caz,~..~t, lr~v~,el~ .......... ..................... Se~t,½el.~ ....................................... to. ja~.,1,d...n®v., el~e.. ~mt.~t ~ .. d~e~.:t .:[.llg ...................................................................................... at premises located at ...Jl[/.~..l~J~ti..~J~l:J~..jJlJ .................................................................................... ................................................. 6 ea~,ho.~! ............................................................................................. pursuant to application dated ............................ j~ .......~.0 .............. 19.6~.., and approved by the Building Inspector Fee $,...~.04.Q0 ........ ...... ...... ................ Building Inspector [ F0~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Teml0o~'a['y CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .WJ'.S.....(Js,~e~..~,~'~;:J,/~..~jo~.d ........ F'"" Street Map No.Y,~Y_qf~ ...........Block No .....~1<3{E ........ Lot No. ,.,'~3{:X~ ....... ~Lo1~;hr~l,d ................ t ............. conforms substantially to the Application for BuiJd~ng Permit heretofore filed in this 9ffice dated ........................................... ~,~.,...~ ...... , 19.~..~... pursuant to which Building Permit No, dated .............................. .~/~. ....... 2..0 ...... , 19..~.~'., was issued, and conforms to all of the r~qHi;~ements of the applicable provisions of the law. The occupancy for which this certificate is issC:"~d ,'is/x ........ Pz'ivate one famil~ d~ellin~ ~ / The certificate is issued to ....C..~.~.:~,..~..t~,.~.]%£t,M%.g.j~. ............................... (,~ZI~. ................. '......,i.~ ....... ~. (owner, lessee or,tenant) ' : ' of the aforesaid building. , /, :' I \ ~,. ~/ S-9 · SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH Date Bldg. Permit TO WHOM IT F~Y CONCERN: The sewage disposal facilities, for a structure located at~ have been inspected by this Department and found to be satisfactory° District Engineer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ..................... f. ................. , Disapproved a/c .................................................................................. (Building Inspector) Application No..~..~...~...~*,~.~ ...... APPLICATION FOR BUILDING PERMIT 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 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 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 Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of th~ Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or allerations, or for removal or demolition, as herein described. The applicant agrees to comply with oil 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, .................................................. Agen.~..o~..ow~e~ ........................................................................................................... Name of owner of premises ...~.~..~t~,~'~,C~ .............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done..Mop No.: ...,~aX]~ ...................... Lot No.: ....~;~; ............ Street and Number ~/~.....(~,~'lS..~rtCl~lr~..~,~[~ ........ ~]~1~-~10-~ ............................ Munici~lity 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 ..... O~..~,~..l~l~ ............................................................................. property Ii whether i,n~ 3. Nature of work (check which applicable): New Building .... · · .:~f~lfaf~Addition .................. Alteration ............. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ................................... 4. (to be paid on filing this application) 5. If dkelling, number of dwelling units ....... ~ ............. Number of dwelling units on each floor If glarage, number of cars .....¢11'~ ....................... 6. tf 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 Dimbnsions of same structure with alterations or additions: Front ....................................Rear Deplh ................................ Height ...... ...................... Number of Stories ................................ 8. D mlensions of entire new construction: Front '"'i ........ ll~ .................. Rear ........ ~ .............. Depth. ~ ......... Height .................... Number of Stories ...... ~' 9. Size, of lot: Front ..... ~0() ............... Rear ..~.(X~.]..~..P~.JJ .......Depth ....... 3.~. ................. 10. Dat~ of Purchase ..............~..~.~ ................................. Name of Former Owner ........... 13~.l~e~..~S.~ .................. 1 1. Zon~ or use district in which premises are situated ..... ~.l,~...~.&.lt.t, ....................................................................... 12. Doet proposed construction violate any zoning' law, ordinance or regulation? .................... 1'/~. .............................. 13. Nar~e of Owner of premises ....~. e~3...~B~].~;~/&.OJ~.Address ......... S~li.%~3,8 ................ Phone No ................ Name of Architect ........................................ : ............. Address ............................................ Phone No ................ Nar~e of Contractor ...J¢~..fl,~t~eh. ......................... Address ....... S~t.t,'~f~'l~ .................. Phone No ................ PLOT DIAGRAM , clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fi ~es. Give street and block number or description according to deed, and show street names and indic erior or corner lot. STATE OFI NEW YORK, ] S c COUNTY iOF I]~t~'~o' ',~1[ ............... J' ................. i...J~.a,.,~T~..JJ,~l~.$e~ ....................................... being duly sworn, deposes and s~ys that he is the ~pplic I(N~me of individuel signing epplic~tion) above na~ed. He is the ................ ~g~...~..~.~ ................................................................................................. (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this opplic=tion; that all statements contained in this application are true to the best of his knowledge and belief; that the w )rk will be performed in the manner set forth Jn the application filed therewith. Sworn to b ~fore me this(,~ (~' ................ ..... . ........ ...... ............ , (, ,-, r,~.., , ~ : .~. ~ '~Notary ' . ............. ;.~*;., ...... . .... ~'"' '~' ~ '" ......... 4 ......................... ' ~~.....~.:..~~ Co~ A. BE6EJI~I '(Signature of applicgnt) Public, ~ , Il NOTARY PUBLIC, State of [~ew Yor~ J/ ~0, 52-3233]20 Suffolk'County ~ Term Expires ~arcil 30,