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Home My WebLink About2832-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No.2~...,.23.2,,~ ............... Date .......................... 'De0emJ~e~......~.¢, 196.~... THIS CERTIFIES that the building located at ~tS.¢..'~t~..~o..,~.~.e.~g..~.$..'¢.O ................... Street , C~',.pt Kid. Map INO ....................... Block No ....................... Lot No. lO} ..........tftO..~;.~t;~OtCt,.....N~,.I, ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................ .~g. tm~ ....... .~ ......... , 19.(~..~.. pursuant to which Building Permit No.28,~2~..~... dated .............................. A.~4§:¢~8.~......~...., 19..6.~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this c.ertificate is issued is ........ · ~i~¢a.te.. ~..:t~amlt~'.. r~we]:.~,.in~ ............................................................................................... The certificate is issued to ..... ~'~.,~.,,...~t~.~],a~../[V~.,~.~O.~ ................. O.~,~f~ ........................... (owner, lessee or tenant) of the aforesaid building· ~ ,% O ~ t ~ H.D. Approval Dee. ~1~0 196~ b~, R~ Villa ........ ~.~.~ .......... .~,~¢~.~ ................ ' Building' Inspector FOI~M NO. ~ 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? 2832 z Date ............................... ,l~t ...... 3'..., 19.65. Permission is hereby granted to: o ~J' ......................... ~at.t,:[ t~k ................................. to.. ~13~t,~1...m(~W...one../tami3~... ~t. wal 3A,r~ .................................................................................... at premises Iocoted ot .....].Ot~..~i03 ....... Ce, pt...l~d...I~ta.tee ........................................................ ....................................... T~,l.e ~. ~..F~e s.t,..1~ ~ ............ Na~ct~.~uek ................................................... pursuant to opplication dated ................................. A~I~12~..-..~ ...... 19..{~.~ end approved by the Building Inspector Fee $.....~I,.Q ,.0.0 ....... Building inspector SUFFOLK COUNTY DEPARTMENT OF HEALTH DEC I 0 19~5 TO WHOM 1T MAY CONCE~: The sew,age disposal facilities for a structure located at ' de -oc a+.;i on) ~ -- have been inspected by this Department and found to be satisfactory, District Engln~E District Engineer FO~M NO. 1 T~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ................... .~..~. ................. , 19 ........ Permit No...~......~.....~......'~...,~ ..._...................~Disapproved a/c ..................................................... ~ ............... ............................... ................................. 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 port of thi~ 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 what~ver 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 all applicable laws, ordinances, building code .and regulations. .......................................... (Sigrt6ture~rapplicant, or name, if a corporation) .... X.,l : .:. . . .z. . .qz.. . .,. . . . .4 /,. ................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder. .................... ......................................................... ...................................................... Name of owner of premises ........ ~~ ........................................................... if applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done .Map No.: ........................................ Lot No.: .....//...~....~.. ......... Street and Number .....~....~.....~.."~..~.~....~..~.~..~_4~.~....~...`~.....~.(?..~.~`)~`~`;~```~`~`~..~.~..~..L~...~.. .......... ...~...~...~.~o'...~....~...... 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'-~ ~..~..~ ./."..~...~.?~..~..~ Z? 3. Nature of work (check which applicable): New Buitding .... ......,.......'~'"~ Addition .................. Alteration ............... Repdir .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... 4. Estimated Cost ...... ./..~.?..~...~ ......................... Fee ...................................................................................... (to be paid on filing this application) 5. tf dtelling, number of dwelling units ............................ Number of dwelling units on each floor ........................ If go, rage, number of cars ......................................................................................................................................... 6. If bHsiness, 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 .............................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ........................ D'ep~h ................................ Height ............................ Numb. er of Stories ................................ 8. Dimensions of entire new construction: Front .......... .~..~.....~. .............. Rear ....... ..~....~..../. ......... Depth ..... ~ .......... Height .................... Number of Stories ....... ~ ...................................................................................................... ' ................................... 9. Size'of lot: Front ..... ,~...~.:.....~. ........ Rear /..¢-O ~ Depth ........... ]0. Dat~ of Purchase ........................................................ No, me of Former Owner ..................................................... 1 1. Zon~ or use district in which premises are situated ................................................................................................ 12. Does] proposed construction via ate any zoning law, ord nonce or regu at on? .............................. 13. Na4e of Owner of premis~..r..~.~/~ff/~.~..'~...i~.~..~...~C~dress ....~.¢~.~..,~.¢.~..~.:/...~..'.~..'Phone No ................. NarCo of Architect ~......~.~..~...~... ............... Address .~..¢...~...~.~..¢.../.../~..~,..~.~..,.........-/- L -/' ~ Phone No .................. Name of Contract~.~..~...~.......Z ..~./.~' .~.~.~.....Address 4~..'~...~....~./..~.~...~....~....~' ~- Phone PLOT DIAGRAM Locat~clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro property li.~es. Give street and block number or description according to deed, and show street names and indicc whether nterior or corner lot. .f STATE OF NEW YORK, 1, ¢ ¢ ' DF ................................ .f "'"" ........ "'.~..~..=.~:.:...~.. ....................................................... being duly sworn, deposes and says that he is the applic Xlame of individual signing application) ~ above named. He is the ..................... .~..~¢Z'.~ ."~..~..~_. ............................................................................. . (Contractor, agent, corporate officer, etc.) of said owper or owners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and belief cJ~d that the w~rk will be performed in the manner set forth in the application filed therewith. // Sworn to b~fore me this ~ ~-, // .................of ............ X3, // : . C ........ ,~ ...... r -: ................... : ............................... , .... Notary Publ,,~~~ County"~~ ..... ¢~na¢~' apphcan,) '~'