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Home My WebLink About2628-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the budding located at ..~t~..R.Q~W... ]~.~ ~,~.TJ...~.0, ............ Street Map No ..... ~ ......... Block No..~;~. .............Lot No ..... ~ ......... .~...~..S...~....~-~..~..O...~.l....~..,...~.~ ...... conforms substanhally to the Appbcahon for Budding Permit heretofore filed ~n this office doted .............................. ~l~J~l~l~.~r.....2~ ......... , 19.6.~.. pursuant to which Budding Permit No .... dated t~ . 19..!? ..... was ~ssued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which thru cerhficate i§ issued is ........ The certificate is~.j~ued to .......Lea~.~..~allm~e .&..~:L~e ......................... ~.e.~,~. ................... (owner, lessee or tenant) of the aforesmd building. "' Bulling ~~' FOI~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.° 2628 Z Dote ...................... ~TalI~g~*.~ .....~ ......... , 19...~.5 Permission is hereby granted to: I~e~..&.~Lta~....l/~Ll~et ..................... to ...... .1~o~.. ~u..aclct t..t;len..,o~ ..arv e:r~l..s t; ~L~...dYe ~.Z4:~g ................................................... ............................... {4ktapreved...by...]~/.&ppea-~.~l ........................................................................ at premises located at .... J:lt~...~.i~.i...~...~. "'~'i:ll'"}tOgt~ .................................................. ..................................... llaat~..lta~.~ ...................................................................................... pursuant to ~pplicotion doted ............................... 0~.~, ....... ~) ........... 19..~., ond approved by the Building Inspector Fee $..~. ~..0..0. ............ ' ' Budding Inspector FOR*.~ N*O. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ............. ~....~.. .......... 19.~..(... Approved ....... ;~..~.....~...~ ......... , 19....~...Permit No ................................. ........... ............. ............................... ................................. Application No. ~.~ ..... APPLICATION FOR BUILDING PERMIT Date .......... ........ .,Z....o.. ..................... , INSTRUCTIONS a. Th~s application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin J nspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adiomlng premises or public streets c areas, and giving a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatio~ c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon opprovaJ of this application, the Building Inspector will issue a Building Permit to the applicant. Suc 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 ~or any purpose whatever until a Certificate of Occupanc 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 th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other opphcable Laws, Ordinances c Regulahons, for the ccnstruction of buddings, addihons or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporabon) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildm Nome of owner of premises .... ..L......~..~...~..?..,c ....... ..~.-.., ........ ~ ....... ..~..~....J.././..~ ...... ~1 ....... ~..~ZZ.~.~. ................ if applicant ~s a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Locahon of land on which proposed work will be done. Map No: ............................................ Lot No: .................. Street and Number ..... J.~..~...T'.,.~.~..../ff.< ...... .~...,~-...4:,...c. ..................... .~..~....u)ff...C¥ ...... .~...~.. ..... .~...~...~....'~.JT...~../...~. .................... Municipality 2. State ex~sbng use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy /..~.. b. Intended use and occupancy ................ 4[,~.,..~T..5../...~.,..~..,./~.....~.....~..: ........................................................................ 3. Nature of work (check' which apt le). New Budding ~ Additil~J~. Alteration Repair .................... Re,,~oval .................... Demolition .................... Other Work (Describe) ..................................... 4. Estimated Cost ........-~.~'...~.~...~....~.. .............................. Fee / (to be prod on filing this apphcation) 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. D,mensions of existing structures, if any: Front ...... ~...~.~ ........... Rear ...~. ..... ] .............. Depth .....~'....~...~. ............ ( Hmght .......~/~ ................. Number of Stories .................... /(..'./...~... .............................................................................. D~mensions of same structure with alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8 D~mensions of entire new construction: Front ............................Rear ............................ Depth ........................... Height ............................ Number of Stories ............................ 9. Size of lot: Front ......... ~..J .............. Rear ............................ Depth ...... L...~..~.' ................. 10. Date of Purchase ...........~..~..~...~ .............................. Name of Former Owner ....~..J..//...~..~..~. ...... ..~....O....~.../.~..~.~. 11. Zone or use district in which premises are situated ........................................................................................ '. ...... 12 Does proposed construction violate any zoning law, ordinance or regulation> ........... /~....C?.. .............................. 13. Name of Owner of premises ../.-..:.'.~......~..&:.../~../.:..~...~../Z../~'.A~ress..~.~...~.J~.~?.....('~ .~..: ........... Phone No.~....~...~.T.?.~; Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor ................... .~... ~])~ .~.....~.,~. ................... Address ....~..~....F~......~........'~...~...~.~.L~...~.. Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro, property lines. Gwe street and block numbers or description acco_~rding to deed, and show street names and ind~cai whether ~nterior or corner lot. STATE OF NEW YORK, ~ ~ ~ COUNTY 05 ...~::: ....................... ~ °'°' , ~ ~ ........... ~_~ ......... ~..~..~ ................................... g duly sworn, deposes and says that he is the applica (Name of indwidual signing application) above named. He is the ..................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and f this apphcation; that all statements contained in this application are true to the best of his knowledge and bali, and that the work w~ll be performed in the manner set forth in the a~plJcation filed therewith. to before me this ~ ~~ , ~ , ~,_ . / ~-' .~_ . . , m::: ,,~,.,~,~x~ .......... : ............. ~.~,; ...... : ................................. Nota~ Public, ..~~..~~ym .~, ~, ..,., t :,~ vo~ (S~gnature of opphcant)