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Home My WebLink About2862-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~t/lB.....~tl~.h...Jr~e ............................... Street Map No...~( ...............Block No....,~IQ[ ........... Lot No. ~ ......... ~e.~.t..}/Je,~.io~e...[~.,.~.e ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. .¢J~]~;.~,. ......... .'1.,~....., 19.6~;.. pursuant to which Building Permit No. '"~8~,~'"Z dated ........................... f~e~t~'i"'"'];,~ ....... , 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 :l:va~ e...o~e...~am~.~7. · ~.l:j:n:~ ............................................................................................. The certificate is issued to ..... '~oJ'/~'"e~:o[o'ek ................. i~,'~'~'r',"~t~ee~"f~'~<~'~¥i.· ............................. of the aforesaid building. H.D.App~'oval ~eb. 2~, 1966 by R. Villa ..... .................... ~ '~Building 'lnspector~ FOP~M 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.° 2862 Z Date .............................. ~]at~llbe~..~., 19..~. Permission is hereby granted to: lr~aee & · Z~.~&e~...A/¢.....~eim ..8~opell .................... ........ ~L~.I le~...~l&oe .......................................... to ... ~t~L~ d.. a~ew.. 4~ne.. ;a~.lT.. &wet t.~.~ .................................................................................... at premises located at ..~D.l~t~...~L~l~e ........(...~.....0~.,]~o.l~-,&t~.). ...................................................... ........................................................ Ea~tt ..~a~,.~oa,.....~,;g;, .............................................................. pursuant to application dated ............................. ~el~0.t, ......... '1.~ ........ 19~.~,, and approved by the Building Inspector Fee $ .~,.Q ~..~. ........... Building Insp~f6r ~-IT' 1"'OWN Or' -'"'OU'T'Ho[.~, ¢ FOP~VI NO. 1 TOWN OF SOUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ~../...~ ........... , 19..~..?...-- ,, " Approved ........................................ , 19 ........ Permit No ..... ~ ....."" Application No. ~L~ ~ u, ~u u~':sa--rove~ a/c ....... ' .................... .............. : ................................. ................................. i'l~ ui Idi n~l nspector) 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 p remises, relationship to adjoining premises ar public streets or areas, 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 Occ'u~ancy 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 alt applicable laws, ordinances and regulations. ' ~ ~ ..... ........ ................. (Signature of opCplicant, or name, if a corporation) (Address of applicant) State whether applican, t is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ................. .................................................................................................................................................... Name of owner of premises ~////4/ If applicant is a corporate, signature of duly authorized officer. ..................................... : ..................... C..r.....' ......................... (Nam~i"~"r~d t~tle of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ..................... .sl .................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .................................... ; .............................................................................................. b. branded use and occupancy .............~..~.~..~..C-.../..~...~ ........ 3. Natur~e of work (check which'applicable): New Building ....~... ......... Addition .................. Alteration ................. Repai? .................... Removal .................... Demolition ........ · ............ Other Work (Describe) ........................ -.' 4. kst~mated Cost ....... ~ ....................................... Fee ........................................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ............~.. .............. Number of dwelling units on each floor .......................... If gar,age, number of cars ............................................................................................................................................ 6. If bu?ness, commercial or mixed occupancy, specify nature and extent of each type of use ............................... 7. Dime?sions of existing structures, if any: Front .......................... Rear .......................... Depth ............................ Meigk~t ............................ Number of Stories ........................................................................................................... Dimehsions of same structure with alterations or additions: Front ................................ Rear .............................. Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ........ ~,.,.~. ................ Rear .,..~..~.. ................ Depth ,..~,.~.,.t..~.~.. .... Heigh, t ...... ............ Number of Stories ...... ................... 9. Size ¢f lot: Front ....... ~.,,~. .................. Rear ....~...~.. ................ Depth ........................................ ' ]0, Datejof Purchase ........................................................ Name of Former Owner 11. Zone~ or use district in which premises are situated ................. . ............ 12. Does proposed constru~fion violate' any zon ng aw, ordnance or regulotionP ' i .... 13. Name of Owner of prem ses~.,~l~/./~......~..~? .~..~.~. Address ~..~. ~ .................. ~,'~'~'~'~,/'~' ~ ~ ~ 7'~ ........ Phone No. Nam' of Arch tect .~..~"~'" .~..~..~.?~]r~.. r ,~ · ~' ~ ://~'/D' ~ ...... e ................................................ Add ess ......~..~.. .......... ' l~lamb of Contractor .~...~.~.:~':. 4 ~..~/~,uj~ ..~.. Address?.~.:~.~,41 .~/.?,l/.~ ..~.., Phone PLOT DIAGRAM Locateiclearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimension property [ir(~s. Give street and block numbers or description according to deed, and show street names and whether in,~rior or corner lot. STATE OF: NEW Y,Q~J(, ) COUNTY ,OF ~]~.t.~f~l.~..: ............ ) S.S. . - ~ , ' cremg duly sworn,"deposes ........ .. ............. :....: ............ :..,.. ..................... (Name of individual signing application) above nam?d. He is the ...~ .................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is ciuly authorized to perform or have performed the said work and to make and this apphcahon; that all statements contained in ti{is application are true to the best of and that the work wiiI be performed in the manner set .f~rth ~in.,the~appl.ication filed therew~t~, Sworn to bbfore me this ............ ..... day of .............. , Notary Puilic, .~,~...~,..~....~.~f~( .......... County and ~ays that he is the applicc i /tTT~ c