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Home My WebLink About2629-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z...2~.~. ............ Date ............................. J~e....2. .......... . 19..6~. THIS CERTIFIES that the building located at .... S,/~atems..~d~e..~/a~. ........................ Street Map ~oa~....~..~.~.e..~.. ....... Block No .~.T~ .............. Lot No .... ~.~ ............ S~jl~t~h~[~[., ..... J[,~.~., ........... conforms substanhally to the Applicahon for Building Permit heretofore filed in this office dated .................................... ~'~_~1~1~.y.....2.1..., 196.~... pursuant to which Building Permit No ...... ~.J~.~. dated .......................... ~TaJl~.l~l_~jt.....~.~.., 19.~. , was msued, and conforms to all of the requirements of the applicable provisions of the taw. The occupancy for which this cerhficate ,s ~ssued ~s ........ · t~.iv~f,e..~ne..£eiai, l~..~t~el.~i~i~ .............................................................................................. The cerhficate is issued to .... ~[~,~[~a,~li..~l.~L~ ........01~Jle~.~,]Blll~;l,~e~. ........................................ (owner, lessee or tencnt) of the aforesaid building [~,'d,,~, nspecY~ FOI~I~ NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2629 Z Permission is hereby granted to: ~lij,...We.]L. te ............................................................. ...... ~La..:r~..~4ri~r~. .................................. .................. 8e,u.thold .......................................... to ... ~ Ld... ne~.. one.._~am~L~....d~.e.'L~.f.z:~ ................................................................................... at premises located at ...l(~t..~ ..... ]~Ja~o.JJ[l~r~'t..~_...~lo.~;~J:~)~l~ ................................................. ................................... I$/l~....Wat, e l~s .. ~1£~..~/a~ ....... 8oatiao3jIJ ............................................... pursuant to application dated ............................ ~T~I~...,:~ ....... 19..6~.., and approved by the Budding Inspector ~)~"[~,ll ~ I~ ~qJ~J~ ~0 ~! ~ 8~[JJ~rli~[l~ Fee $"[~)t0~ ......... SUFFOLK COUNTT DEPARTMENT OF HEALT~ D~e TO WHOM IT MAT CO~OE~N: The sewage disposal facilities for a structure located at ~< , ,~ f~, -f~,~ ~ _ -vz,"'~? (Give deed lOCation) · ~~, ~ ~~_. ............ have been inspected by this Department amd found to be satisfactory. .... Dis'tr~c~ Engineer ' " TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ...... , Approved .... ;~......~...~ ........ , 19..(?).~..Permit No .... ~...~...'~...~......~.... .... Disapproved a/c ...~.~..c.¥.. ..... ..~......~.i....~.~.~.. ...... ..~.~..~..~..~....~.....!.~...~./. ...... ............................................. .............. .......... :'"" ........................................... APPLICATION FOR BUILDING PERMIT Application No....?..?....~..~. ......... Date....,,,T~.~..~'~..~.~ .............................. , 19..~..~..... INSTRUCTIONS a. This apphcat~on must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildi, Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adloining premises or public streets areas, and giving a detailed description of layout of propertymust be drawn on the diagram which is part of this applicatic c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of th~s application, the Budding Inspector will ~ssue a Building Permit to the applicant. Su, 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 m part for any purpose whatever until a Certificate of Occupan shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to tl Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulahons, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. ............... .................................. (Sigtnoture of applicant, or name, if a corporation) (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build, Owne~ Name of owner of premises If apphcant is o corporate, signature of duly authorized officer. (Name and t~tle of corporate officer) I. Location of land on which proposed work will be done Map No: ~..8:.~.,...~.~.e...~.....B:.~...~.o..~.o~:~ No: Street and Number Wate~=e.d,~e .................................................... ~'6'~','~i~ii~; .......................................................................... 2. State existing use and occupancy of premmes and intended use and occupancy of proposed construction: a. Existing use and occupancy ................................................................................................................................ b Intended use and occupancy 3. Nature of work (check which applicable). New Building ....... ~ ........ Ad&tion .................. Alteration ................. Repmr .................... Removal .................... Demohhon .................... Other Work (Describe) ..................................... 4. Est,mated Cost ...... .~. .3; .6. .*..0. .0. . .0. ~.9. .~. .............................. Fee ...~...~.0...'..0...O. ........................................................................ (to be prod on filing this apphcation) 5. If dwelhng, number of dwelling units ....... .~. ................... Number of dwelling units on each floor If garage, number of cars 3; 6 If business, commercial or mixed occupancy, specify nature and extent of each type of use 7. D~mens~ons of ex~sting structures, if any: Front .......................... Rear .......................... Depth ........................... Height ............................ Number of Stories .............................................................................................................. D~mens~ons of same structure w,th alterations or add,t~ons: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8. D~mens,ons of ent,re new construction: Front ..... ?..,&.~,..~..0.. ........... Rear .....6...~. ................... Depth ....~ .................. Height .......~..~. .................. Number of Stories ....... ~ .................. 9. Size of lot. Front ..?..~. ~..6...~. .............. Rear ..... ~.0..0.. ............... Depth ~ ........................ 10. Date of Purchase 19§? ........................................................ ~,~ame of Former Owner ....................................................... 11. Zone or use district in which premmes are s~tuated 12 Does proposed construction violate any zoning law, ordinance or regulation? ........ ~.Q ........................................ 13 Name of Owner of prem,ses ..~.;~...~.~...~/.e..]....~...8. ....... Address ..~..~..~'...~.e.~.~....~...°.~..°.~.C~hone No. o.~..O....~?...~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....~.~..]...~.~.~..~....~.e..~..8. ................. Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether exishng or proposed, and indicate all set-back dimensions from property hnes G~ve street and block numbers or description according to deed, and show street names and ~nd~cate whether interior or corner lot. STATE OF NEW YORK '~ COUNTY OF .... ........ s s. 7 z/'' ...................... ..W.~..~.,~k~..l/¥]~. ........................................... being duly sworn, deposes and says thor he is the opplicont (Name of in&vidual signing apphcation) above named. He is the ............. .O...~..~..e...~. .......................................................................................... (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 file th~s application; that all statements contained m this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application fried therewith. Sworn to before me this Zl~ ~, ~ J~ry ~9.~.. Notary Public,., ,.~r~b~ ...... County (Signature of ~pplic~nt) N~ ~ub ~ , 5h~te of New ~ork