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Home My WebLink About2772-zFOP,3i NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. g..~.~.]..~ ............. Date ............................ aept......'l~ ...... , 19..~.~.. THIS CERTIFIES that the building located at ..]Reok. M...~.o.i.tn¢...R~ad. ............................. Street Map No...~ ............... Block No....~ ..............Lot No...,~ .......~O.S.~..~[x~O~t...~[~,.~, .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................... ~[~M ......... ~.'~ .......... , t9~.~.., pursuant to which Building Permit No. P,.7.~.~-..Z.. doted ................................ I~r. ...... ~.%. ..... 19.~.~.., 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 ........ ...... P~i.v.a~e.. e~e, · .t:a.m.i.~y. · 4~e ~.]:'I. ~ ........................................................................................... The certificate is issued to ..A~6e...P~t'I~O~.~S ........................... 0~"~e~'. ................................... (owner, lessee or tenant) of the aforesaid building. I/.l..Appro~al Sept. 1%, 196% bM R. Villa ........ ' ...... .................... ~ , uuila~ng ,n~p6c~or ~. 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? 2772 Z Date ................................... ~ .......~'......, 19~... Permission is hereby granted to: · JU~e.....P~aa~el~leu~ .................................. ........ ZZliiiJJga~....8.~..~..~Ol~t~..~t ............... ................... Now...¥~vk~ · · · 1~. ~'.,, ........................... to ...... ~.. J)ti.:J:l. ~.. Del~"or~e" ~8,ql~..'1 ,y,.- ~fe']: 'l'ltlg' ......................................................................... at premises located at ...J',~....JJO~y:..~t..JJOR4 ............................................................................... ................................ Ea,~..~.l~omr ....... 1~,.~., .................................................... pursuant to application dated ....................................... ~ ....... ~.., 19.~.~.., and approved by the Building Inspector Fee $....:],.C).DO ........ FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application N ........................... t~ ~ - Approved ........................................ , 19 ...... Permit No. . . Disapproved a/c ........................................ ~...,~.~ ........ z~ .................. /~ ......................... ;~. ..................... ...?..7.~.' ............................ ................................. APPLICATION FOR BUILDING PERMIT Date ..................~ ' ~J~' 19. 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 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 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 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 o 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 ali applicable lows, ordioances, building code and regulations. (Signature of applicant, or name, if a corporation) .......... (Address of applicant) State wk~ether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....... ~.....C-:~..~...~.~..~..~.......~>...~.i..~...,.~.....~.;..~.D...~...~... ......................................... 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. Map No: ................... ] ......... : .............. Lot No: ........... ~ ........ Street Number .......................... ~ .................................................................. : ........................ Municipality 2. State existing use and occupancy of Dremises and intended use and occupancy of proposed construction: a Ex st n use and occu anc ~ ~ ~ ~J/ ~ g P Y ................................................................................................................................... b. Intended use and occupancy ...... ~..~../~..~.~.~.~ ......................................................................... 3. NatUre oF work (check which applicable): New Building .................. Addition .................. Alteration po.r .................... R~,,r~oval .,:~ .............. Demohhon .................... Other Work (Descnbe) ..:, 4. Esti~nated Cost .... /..~.....~..~..~...~.. Fee ................ L~..,.,~-~.. ..................... ~.~ I (to be paid on filing this application) 5. If d,Jwelling, number of dwelling units ........ 1 .................. Number of dwelling units on each floor If g~rage, number of cars ....... 5. ......... ..;.TT. ....................................................................................... ~ ...................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. Dimensions of existing structures, Jf any: Front .......................... Rear .......................... Depth Height ............................ Number of Stories ........................................................................................................... Dimensions of same structure with alterations or aad'tions: Front ................................ Rear Depth .............................. Height ............................... Number of Stories Dimensions/ of entire new construction: Front ....... .~......~.. ......... Rear ...... .~,....~. ...... Depth ......~....~ .......... Hei~jht ..... /...~.. ................ Number of Stories ..,../...?~.. ............... ~J-" . ...... .~......~.. ........... Depth ..................... Size'of lot: Front ...../.......~ ............. Rear .~."¢~'~ .......... Dat~ of Purchase ...... ..*~....~..~.,~......~....~.. ..................... Name of Former Owner ...\~,?.:......~..,..~....~..~..[~ Zon~ or use district in which premises are situated ............. ~..~. DoeI proposed construction violate any zoning Iow, ordinance,or regulation? ,../~... ~ Na~e of Owner of premises/~J.'.~.~..../~.~...~.%. 0 .~..~Lm~'~Addres .,~.., ~.. /~,~. -~','~ 7G .~..: ,.z/.t~hone No.~ Name of Architect ...................................................... Address ............................................ I~hone No. ' ~~ /'7~/'~' .~...¢, ,~,?'..~., .~....~...~. ¢ .....~:..'. ~: ..... P'h one N o ,' Name of Contractor~.. ............... ..~..'. ........................... Address 10. 11. 12. 13. L.ocat~ property li~ whether PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr ~es. Give street and block numbers or description according to deed, and show street names and indic, erior or corner lot. STATE OFINEW Y~t~K,//_ .,2.~ S" COUNTY p~F ~~'~' ~ , '.~.~~~ ~::~- ~~ .......... ' being duly sworn, deposes and says that he isthe (Name of ind~wdual s~gnmg apphcat~on) above named. He is the ...~ .............................................................. ~ (Contractor, agent, corporate officer, etc.) of said owber or owners, and is duly authorized to perform or have perf6rmed the said work and to make and this application; that all statements contained in this applfcation ore true to the best of his knowledge and bel and that the work will be performed in the manner set forth i~ the a~plication filed therewith, z, Sworn to~ef~e this /I -- , // , ~ : .......... Notary PuNic, ~....~z,.~.5.~~r~ P,b~,~, State of Ne~ ~gnature of applicant) ~ / ~ ~.~ No. 52.034.1963. Suffolk County I" ~'~ Conm~ssion Expires ~arch 30, ~9~