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Home My WebLink About2788-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ,~,.22~.~ ............. Date ............................. I9..65.. THIS CERTIFIES that the building located at --~/'~.....~.~...~¥e ....................................... Street' Map No...~:~:~. ............ Block No ......... :Y,~ ......Lot No....-v~l~ ....... F.~l.~.t,..~k'trioIl~.....~,.~'., ......... conforms substantially to the Application for Building Permit heretofore filed in this office dated .............................. Jl,l~e.....~. ................... , 196.~... pursuant to which Building Permit No. '~'8"Z' dated .................... ~r.l~e. ....... :L.O. .............. , 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 ........ ~.r iv~t e...or~e...~'amily...d~.e ,1.~,in~ ................................................................................................ The certificate is issued to ..]~,~..,fJ~tU,~.]....~'-~.~t£.~.~.~. ................ ~/~ ...................................... (owner, lessee or tenant) of the aforesaid building. 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? 2788 z Permission is hereby granted to: Ohet.¥ "e~'o~d'""~'""l~';'"B~;'" T~af£~ea to Bu~ ..an.. &dd:~.t~.c~n..~n.. &r~ ..e~$~t ~ .. ~®tt.$n~ ......................................................... ct premises located at ..... W'~'""J~/'"'"J~'IB' ......................................................................................... .............................................. F.a~t...J~j,$en~ ........ g.~.¥.~ ............ ~ ......................................................... pursuant to application dated ...................................... ~Tll~e.....9 ..... 19...6~, and approved by the Building Inspector Fee $'~"~00 ............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, to Examined ...................... 19 ........ Approved ............................ .~;.5 ........ 19 ........ Permit No. Disapproved a/c ............ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completely filled in by typewriter ar in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, rebtionship to adioining premises or public streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is port of this location. 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 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, far the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and ~gulations. (Signature of applicant, or name, if acorporation) ................. ...................... (Add, ss of applicant)/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of prem~ses.....~< ' · ......................................................................... If applicant is a corporate, signature of duly authorized offioer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: -- Lot No: .....-5. .............. Street and Number ................ .~ ...... ~ ....................................... / / Municipality State existing use and occupancy of pr,emises and it~tende, x~ use and occupancy of proposed construction: ...... .................................................................... Existing use and occupancy 3.Notur~ of work (check which applicable): New Building .................... Addition ..... ,~ ......... Alteration ................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... Cost ........... ~....'.....~.. ........................... Fee (to be paid on filing this application) 4. Estimqted ~,. ......... .~..'~..,~,,., ,~,. ................................................................. 5. If dw~ ling, number of dwelling units .......... ( ..................... Number of dwelling units on each floor ............................ If gar~ ge, number of cots ................................................................................... 6. If bu,'iness, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dime~;ions of existing structures, if any: Front ....... 2.,.~... .......... Rear ....... ,..-~....,.~,. .......... Depth ~r....O.. ................. Height ...."~.....~. ................ Number of Stories .,.~(,:~'~A~_. ......................................................................................... Dimenfions of same structure' with '6Iterations or additions: Front ~' ~ Rear ~ ~ Depth i..,..~....~. ................. Height .....~. .................... Number of Stories ................................ 8. Dimenlions of entire new construction: Front ............................Rear ............................ Depth ............................ Height] ............................ Number of Stories ............................ 9. Size oi lot: Front ........,~,,,,,~.-. ......... Rear ......... ~.....-~'... ......... Depth ....... ,/.....~.....'~.. ....... 10. Dote of Purchase ................... ~ ................................. Name of F,ormer Owner ..... ~ ................................................ 11. Zone Or use d~stnct in which premises are situated ...... /~,,,, ,~ '. ................................. Does iro osed construct on v olote ony zoning law, ordinance or regulation;) ~ ' ,2. · .... ....................... 13. Name ~f Owner or premises.....,.:~c...~,:L../,.c.~,~aaress ................................................................. Name ~f Architect ........................................................ Address .......................................... Phone NO ..................... Name ',of Contractor.~.~...~.,.~. ............. Address ~~ ....... y....Phone NO~..~...~.,Z .~..,Z- PLOT DIAGRAM Locate cl!early and distinctly ail buildings, whether existing or proposed, and indicate ail set-back dimensions from property hnes.! Give street and block numbers or description according to deed, end show street names and indicote whether interirr or corner lot. j "~ '~ ¢1,,~--~- ,~,~! ~ ! I .. ~.....~~: ........................... being duly sworn deposes and says that he is the applicant ........ (Name] of individual signingo~ ~applicati°n) ~ ~ , above named He is the ~~ ................................................................................ ',' ........................ (Contractor, agent, corporate officer, etc.) of said owner o~ owners, and s duly authorized to perform ar have performed the said work and to make and fi~e this app]ication;~that a~ statements contained in this application are true to the best of his knowledge and belief; and that the we~k will be performed in, the ~nner set forth in the ap~ication filed~er~ith. Sworntobe~re~ethis~ -- .~ ~ (] ~ ~( ) /J- ~ ~.*