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Home My WebLink About2840-zFOR~I[ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. 'g"2.~'9(~ ............ Date ........................... ~O~lb.~'..~.~..., 19...~'. THIS CERTIFIES that the building located at ..~N/8....P.~1'~.sg...Tr.t~/~.,~Qa~ ..................... Street Map No....~.~ ............ Block No ....... .~r~ ......... Lot No. ~ ....... ~.~.Qh.O.g~lee.....~.~e. ............... conforms substantially to the Application for Bui]ding Permit heretofore filed in this office dated ........................... · A:~t~. .......... .~) ......... , 19.6..~.. pursuant to which Building Permit No..28.~.0..~ dated .............................. ~ilg.gs.t.....],]..., 19..6.~., was issued, and conforms to all of the requirements of the opp[icable provisions of the law. The occupancy for which this certificate is issued is ........ · .Pr ive.~ e...one" ~am~ .]:y.. ,~we~i.~ng ............................................................................................... The certificate is issued to .....Wel.tez~..&..Eelen..Xe~s3,e~ ......................... ~er.e .................... (owner, lessee or tenant) oF the aforesaid building. H.I'~. Approval Oct 29 !96~ by R. Villa f,, .............. ....... .......... Building Inspector t- FORM NO, 2 TOWN OF $OUTHOLD 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? 2840 z Date ............................ ~.lZ&q~t.....l'! ....... , 19...~t~ Permission is hereby granted to: ....... z~x....~.~,~ ...................................................... .............. l~t..~.~ .............. l~Llle~'...lq, au .......... to ..,.~,l~[~d.. ~.9/.. ene..te~...d~ee.. 4 ~ ................................................................................... at premises located at ...... ~Id.8.....[J. ae..1~e..ttoad .......................................................................... .................................................... Cu,t~hog:~,m.~......l~,.~, ....................................................................... pursuant to application dated ....................................... &U~.....IO .... 19.~.~., and approved by the Building Inspector Fee $..]JJ~ .,1[~0 .......... ........... Buildin~"i~:)ector ...... [ ........... SUFFOLK COUNTY DEPARTmeNT OF HEALTH Building Permit No. ,~ TO WHOM IT MAY CONCERN: The sewage disposal facilities for a structure located at (Give deed location) have been inspected by this Department and found to be satisfactory. .... ~iS'~rict Engineer FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, Exam,ned ........... 19.LC · ~J ~x 19 ''! PermtNo ~q~ ApprOved ........................................ , ......~..~.~.... ~ Application No. ~.~......~..~'..~. ......... "/"~'(l~ld,ng Insp c~or) APPLICATION FOR BUILDING PERMIT Date ........................................................ , 19 ................ INSTRUCTIONS a. This application must be completely ill[ed in by typewriter or in ink and submitted in duplicate to the Building tnspector. b Plot plan showing location of lot and of buildings on premises, relationship to adioining premises or public streets or areqF, 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 pa rt 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. ordinances and regulations. ~, ~:~Theapplicant agrees to comply with all applicable laws, " (Signature of applic~t; or name, if a corporation)' . . t. , . . . . . _oCt .4 . . . 7. ,. . . ?. .(. . . . ¢. . . . ./4. . . (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................... ........... ........ . ................................................................................................. Name of owner of premises ..~..~../~ .~...~:..~...... ...... 4-./~...~..-~...~.../~.. ,~......~.....J~'....~.C.~_ If applicant is a corRorate, signature of duly authorized officer. ' " '~(N m ~'nd ' p ........... 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ...... .~../..~.~........~.....~....~..-- -- ........ .~.Z~..~.....~.~. ................. ..~C.....~.~..~/.~..O....~...C .~.. ............................ Municipality 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 ............ ..~./..../~...~....~...~.~.....7~..~.~..L(..~...~../~.~..~...~/...~...`~.. ........................................... 3. Natuire of work (check which applicable): New Building ...~ ..... Addition .................. Alteration ............... Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estin~ated Cost ..... /.. ~..~'. ,, .~...¢~....~ ......................... 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, Dimfnsions 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. Dime,nsions of entire new construction: Front ........~....~.. .............. 'Rear ..... .~..~... .............. Depth ..,~,..~... ....... ~..~. d. 52.'. Height ..... ............ Number of Stories ......l../..z. .................. ' ' ' · ,..:...- ,..:..... - 9, Size bf lot: Front ..... /..~...~. .................. Rear .../...~.,~. ................. Depth 10. Dote:~of Purchase ,/]..~....~'....*.../.~..~.~ ........................... Name of Former Owner Z~.q...o.,~ .~ .~,...~..../~.../~.//... 11. Zone or use district in which premises are situated ..................................................................... 12. Does' proposed construction violate any zoning law, ordinance or regulation? ..... ~ ....................................... 13. Name of Owner of premises/&'.ff.~/.~.....~..~,~(..&-.~.......Address ..~..~,/~/..~.~.d..~...~..&.~,..-Y,h'...¢~..."..~'. Phone No .................. Name of Architect ~..f.~.f.~...J....~..a.~.~.~:.&~., .............. Address ..'~..,..,~..~.~..Z~...~.~/.¢./~ .~..~..~.r.. Phone No~.//~..~/.~.'~.! Nam~b- of Contractor ~...~.~..(.~':....~/.~.~.~..~.~..,~' ......... Address ............................................ Phone No ..... ./.~. .......... PLOT DIAGRAM Locate~ clearly and distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensions fro property lin'es. Give street and block numbers or description according to deed, and show street names and indica~ whether interior or corner lot. STATE! OF NEW YO ,L"K-~ ) c c COUN'F.Y QF ............................ ) °'°' ...~r~....-~.'-....~.~.~ ..................................... being duly sworn, deposes and says that he is the applic¢ (l~lame of i~fdi~idual signing application) .~ . , named. above He is the ........ ~...~4~,~..~-~._ .....~....~.~. ......................... ~ ~' - (Contractor, agent, corporate officer, etc.) of said owr~er or owners, and is duly authorized to perform or have performed the said work and to make and fi this applicqtion; that all statements contained in this application are true to the best of his knowledge and belie and that th'e work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........ /(...~?. ........ day of ...../7 "'-'"./~.../...~'..~....~'....~..../..........: ...... , 19...~.~.--, ..w~,~..~''~ MFc~mmi,%ib~pires~vm~,30,19 r~ . ~ ;t,/' I//9° ?