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Home My WebLink About2803-zFORmal NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATe OF OCCUPANCY THIS CEP~TIFIES that the building located at ...... ~B,'~,.'~.~..T.a .......................................... Street ~..~....~...~..O...~.?...~,... BJoC~t~.i..o..~.....~. ............ Lot No. ,.3gt.....O~.e~p~.~t...~,~, ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... ~.l,~e ......... ..~Cl....., 196.~..,. pursuant to which Building Permit No...-~P~.O~...~ dated ................................ ~I~]..~......~L ....... , 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~.~.~e..one...~a~$.l~r...d~l.~,n~ .............................................................................................. The certificate is issued to ....~Jl~..~,~e~.~...B~ild~s ................. O.'¢t~.S. ...................................... (owner, lessee or tena,nt) of the aforesaid building. H.D.Approval Aug. 10~ 196~ by T~. Villa ........ ...................................... ................ Building Inspector FORM NO. 2 TOWN OF soUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BI~ KI~PT ON THE PI~I~MISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2803 Z Date ........... i ............. ,~!~Jl~ ...... ~ ............... , 19J~... Permission i~ hereby granted to: l~o~'.th...l~a.$~...i~iii.l~le~{{...~[ne ........ ? L....; ...... to ....*~o'..b,a&14..j~ew..~e...~'a~l~,:~y..~l~et.~*.~ ......... :..... ............... ..: ........ ~ ...... ~ .......... i.....~ ...... :..~ at premises located at' ~O~,..t~"3~t, ....... J~/9,~lke~'"~J~[~ .................. ; ................................................... ......................................... .l~s.t,e~..Sh~e~.....(l~e~Fo~..-l~,,;.~/,..' ......................................... pursuant to application dated ............................... ~TUIIe.,...,~O....~....,' 19~,.., and approved by the Building Inspec~6r~ Fee $.10,00 ........... Building Ins~or $-9 $CHD SUFFOLK COUNTY DEPART~NT OF HEALTH o~te__ AU~ 1 0 1965,,_ Bldg. Permit No..__..__.._ TO WHOM IT MAY CONCERN: The ee~ge dis~omal facilities for a structure located at (Gi~e deed location; have been inspected by this Department and found to be satisfactory. District Engineer TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ..., .......... , 19 .... Approved ........................................ , 19 ........ Permit No ............................ Disapproved a/c ............................... ~ ..... .-.~.~ .'.; ....................................... ~.'.~'. ..... ................................. ................................. APPLICATION FOR BUILDING PERMIT Date.: ...... ~ ...... -- -~ 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 appllcant. 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 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 all applicable laws, ordinances, building code and regulations. ................... .......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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 and Number .....~.... ........................... .,..........:....::: ........ ~,....,... ....................................................... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..... :~..! ........................................................................................................... ' .~ b. Intended use ond occuponc¥ ...... · .! ......................................................................................................... 3. Nature of work (check which applicable): New Building L'/' Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ................................. 4. Estij'nated Cost ............. ~ ............................................. tee ..................................................................................... (to be paid on filing this application) / u bar ....................... 5. If dwelling, number of dwelling units ............................ N m 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. DinJensions of existing structures, if any: Front .......................... Rear .......................... Depth ....................... Height ............................ Number of Stories .......................................................................................................... Dirrjensions of some structure with alterations or additions: Front ................................Rear ........................... Dep'th .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....... .~,.~,.~.~ ............ Rear ..... .,5...-'.,o,...~ .............. Depth .....~....~...~.~.~.~.., Height J ~'" Number of Stories ./. .......... ear .................. ~.. ....... Depth..../...~.~...~ ................. 9. Siz~ of lot: Front ..../...0...~_.,...~....~.__ ...... R ldo, ~' 10. Dat~ of Purchase ...... .,~f4:~C...m..~..~.-. ......................... Name of Former Owner ..~....~,..~ ...... 11. Zor~e or use district in which premises are situated ....... ~ ....................................................................... 12. Doffs proposed construction violate any zoning law, ordinance or regulatioh? ......~..O. .................................... ' Phone"h°ne No.N°' Z 'Zr'e" 13. Name of Owner of pre,~ises~...~...~ .~...~ress NoTe of ........ Address ...... .............. .hone PLOT DIAGRAM Locat~e clearly ond distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fr property li~es. Give street and block numbers or description occording to deed, and show street names ond indic whether interior or corner lot. I,.¢'o ' STATE OF~ NEW YORK COUNTY OF ......... S.S. ~ ,~, ~, .d. ,~.~...~ ~.. ~.. be n sworn, .......... ~ ................................... g duly deposes and says that he is the apptic (~ame of individual signing application) above na~ed. He is the ....................................................~.~ ..................................................................... ~ (Contractor, 9gent, corporate officer, etc.) of said owher or owners, and is duly authorized to perform or have performed the said work and to make and th s ~pp cation; that all statements contained in this application are true to the best of his knowledge and bel and that the work will be performed in the manner set forth Jn the application filed therewith. Sworn to before me this ....... ~0 Z~..... day of ........... .~.~.~ ................. , 19~..~ ....... .. Notary Public, ~ ~"¢ (S~gnature of apphcant) ~ ~ ~ ~No. 52.? ~m,~ ~ Yor~ ~' P es March 30. ~ r