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Home My WebLink About2897-zFO~M NO. 4 TOWN OF SOU~HOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~/~q..B.~t~.t,..La,...~...~.t,~...~.~e. ....... Street Map Nc~Q(~ ................. Block No....~ ........... Lot No ..... ~;~,..G,l~e.~.t,,...~.~.....~..O..~..~. ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................. .O~;O~e~...,].]. ............ , 19,~5.,. pursuant to which Building Permit No..~1.~.~...~. dated ..... : ......... i.....O.~..~..~.e.~...~,.~ ............ , l c2...6..~..., 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 ..~ ..... ................................ adcl~,.tJ, o~ ...t:o...one...~m~...z.~,....~..~ ~.~ ......................................... The certificate is issued to ......... ..H..u..~..~....~.~..~?~.e.....D..~..~ .................................................................. (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 PULL COMPLETION OF THE WORK AUTHORIZED) N? 2897 Z Date ............................... 0~tebe~.....~[:~.., 19...6~ Permission is hereby granted to: H,..-E~e~e..D~,.~,~n .............................................. ............ G~eenpel,.t .............................................. to . ~-Cl.. ~11.. ~¢~,.t:l, GIl.. el~. ~..~l~,l~t-t ~.. ~2,~,~,1~ ........................................................ at premises located at .........~//S..-.~I~I~..~..~..~i..~G~I ........................................................ ............................................ Gr. eenl:~..t ~ .....g..Z.. ................................................................................. pursuant to application dated ................................ O~.t. ....... .1~, ...... 19..6.~., and approved by the Building Inspector Fee $..-~..00 ............ / Building InSpector FO~tM NO. I TOWN OF SOUTHOLD BU~ILD~ING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y,~ Examined ........ ~....~....~... ......... , 19.....~...0~ , ', Approved ....................... I, ................ , 19 ........ Permit No ........................... Application No ..... · .~....~..?'.....~. ..... Disapproved a/c .............................................................................................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ............................ 0at abez',.,.. 11......, 19..6.~ ..... 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 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 shell be occupied or used in whole or in part for any purpose whatever until o 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. ............................................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect.., engineer, general contractor, electrician, plumber or builder. ...................... ........... Ow~e 27 ................................................................................................................................................... Name of owner of premise~'j.;...~13~P, zle..13Z'.~.tzl~ ................................................................................................................. 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.: ....~ .......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..c]'~f~lJ.rt~ ............................................................................................................... b. Intended use and occupancy .......... !! ......... .W/....a.d~l.i.t;io~ ................................................................................ 3. Nature of work (check which applicable): New Building Addition .....~c.~... Alteration .................. Repair .................. I~oval ..................Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ....... .~..~.t~'.~ ......................................... Fee ...$.~.~ ................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... Q~ .............. 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. Dimensions of existing structures, if any: Front ....... .~...~.. .............. Rear ........ ~...~.. .................. Depth ~.....~....~..~.~... Height /~.~7. .................. Number of Stories ../. ........... . ............... Dimensions of same structure with o.lterations or additions: Front ........... .~.~. ................... Rear .....'~'.'.~. .................. Depth,,~L.~....~'.. ................ Height ....~.. ................... Number of Stories ..... ./. ........................ 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number~f Stories 9. Size of lot: Front ..... ,.JL:~...~Z.f~Rear iiii[ii[~'.'~ii['.~.'.iiiiiiiiiiiii"~'~1~'iii~.~iii~.~.'~.'i~ ................................. ]0. Date of Purchase · ..~.~...../~...../.~..~..~.. ....................... Nome of Former Owner ..~'..~4~'~..4e'.~....~...~.6/~.~/..~.~.~... ............ ] 1. Zone or use district in which premises are situated ............ L~JJ...~.S.~ .................... ~ ............. 12. Does proposed construction violate any zoning law, ordinance or regulation> ~.~. .................................. 13. Name of Owner of premises .[1,1.~.~.Z3.e...]~,~..Ll~]~ .......... Address .~..~.~J3~..o..~'.~. Phone No ..................... Nome of Architect ...................................................... Address ........................................... : Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM ~ ...... ~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, ~ c ~ COUNTY OF .,.S~f~lk ........... ~ .... ...~./.~g... ~..~ ~...~'x;~....... m~ .~,//'~'4~.. ........................................ being (~me of individual signing application) above named. He is the (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to ~ke Ornd file this application; that all statements contained in this applicat on are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h inthe appl cahon' "fded therew th. Sworn to before me t~Js ............... /4~... day of .~.~ ............................. , 1~ ~/ ~ ~ - ................ ~ , ................ Z~; .~(..~. .... ..~,,~.;.;~, ~ ......... ~ounty ~ ~ignature aT opp cant) duly sworn, deposes and soys that he is the applicant