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Home My WebLink About2647-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, hi. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .E/~...._A..~.fl~k(~.~f~.....~....~..e. ....................... Street ~w H~ad CoVeN, . ,,u ....................... ~,OCK No ..................... Lot No .8 ............... ~..~.¢~O~,~...G.t ....... ..~..*...~.? ............... conforms substantially to the Application for Budding Permit heretofore filed fn this office dated ............................ ]~l~1~r. ....... ~(~ ....... 19~... pursuant to which Building Permit No ..... ..~..~...~.~..~ dated ...................... .?. ................. .~. ............ , 19..~..~.., was issued, and conforms to all of the requ,rements of the applicable provisions of the law The occupancy for which this cerhficate is issued is ........ ....... · ~i.v~te...oz~..~a~tlY...~w~tllr~ ....................................................................................... The certificate is issued to ...... .l~il.'~[5~q.....~.~.....O..'. ,'[~...clk...~X,.. ................... .0...t~..~?.. ................................... (owner, lessee or tenam) of the aforesaid building H.D.Approval Aug ~, 196% by R, Villa , _..._ ........... ......... ......... Building Inspector ~ 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 FULL COMPLETION OF THE WORK AUTHORIZED) N? 2647 Z Date ................ ~lt);~q3Z'&l~ ......... ~6 .......... , 19.6~... Permission is hereby granted to: to. ~tt3.t:].ct ..a~a~...Oa~.. ~.m~:[~.. 4'~e;[ 3.~.r~ .................................................................................... at premises located at .]A3~....8~......~Ztg~e~ll~..~,~,-~ ............................................................... .................................... Arr. c~h~ad~. ;La, ............ ~eeom~ .............................................................. pursuant to application dated .............................. _~iS~]X ......... 2J~ ......... 19.~.~., and approved b7 the Bu,lding Inspector Fee $. ~1~1 ................. SCHD SUFFOLK COUNTY DEPARTMENT OF HEALTH ~ldg. Permit No. ~ ~ 7 TO WROM IT MAY CONCERN: The sewage dis~o~al fac~lities for a structure located at have been inspected by this Department and found to be satisfactory. District Engineer FO]~ ~0. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................. Application No...'~...o.(¢..~!...] ......... Dlsapp rove~ ........................ ~.u:: ................................ APPLIGATION FOR BUILDING FERMIT Date .............. ........ ..................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the BuJldir Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets 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 approval of this application, the Building Inspector will issue a Building Permit to the applicant. 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 whatever until a Certificate of Occupant 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 ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe~ The applicant agrees to comply with all applicable laws, ordinances, building code and regula~io/~s. ......... ....... Name of owner of premises .................................. ~. ................................................................. If applicant ~s a corporate, signature of duly authorized officer (Name and t~tle of corporate officer} 1. Location of land on which proposed worJ(, will be done. Map No .......................................... Lot No: ..~.....~.... Street and Number .... ..~..~ ............. ....~......~.. .............. ~....~ ....... ...~...~ .................... Mumc~pality 2. State existing use and occupancy of premises and/nten~dx~duse and occupancy of proposed construction: a. Existing use and occupancy ........................-.~....:.r.;.nm:z:.~/,-'r~/~'~"~ ................................................................................ b. Intended use and occupancy ............................................................................................................................ 3 Nature of work (check which applicable): New Budding / Addition Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ..................................... 4 Est.mated Cost ....... ./..~. ~....~..O...O. .................................... Fee (to be paid on filing this application) 5. If dwelhng, number of dwelling units .............. .~. ............ Number of dwelling units on each floor ........................... If garage, number of cars .......................................................................................................................................... 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use ............................... 7. D~mens~ons of existing structures, if any: Front ..........................Rear .......................... Depth ........................... Height ............................ Number of Stories .............................................................................................................. Dimensions of same structure w~th alterations or additions: Front ................................ Rear ............................... Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of ent,re new construction: Front ........... .~...~.. ......... Rear .......... .~....~/. ........... Depth ......~.~;. ............... Height ............................ Number of Stories ....... /. ................... 9. S~ze of lot: Front / Z6'" Rear / $ °~' Depth / 10 Date of Purchase ........ .~. ...... ..~ ....... ./..?.~.~./.. ......... Name of Former Owner 11. Zone or use d~strict inrJwhich premises are situated .................................. .~... ......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ./...~f2 ....................................... 13 Name of Owner of premises .....~...~. ......... ~..~.~ ........Address ..(.?...~.....~....~.../~...c~..... Phone No. Name of Contractor .,~2 ....... ..~..nd,,cyJ ........................ Address Phone No.../.,~....~:.,s.?../.~ PLOT DIAGRAM Locate clearly and d~stinctly all buildings, whether existing or proposed, and indicate all set-back dimensions frof property lines. Give street and block numbers or description according to deed, and show street names and indicat whether interior or corner lot. /2l. STATE OF NEW YORK, COUNTY OF ............. "-"w'^'-'"'"~ .... ..... ~ ................................................ ~) be'ng duly sworn, deposes and says that he s the opp ic~ ................ ...................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the said work and to make and th~s application; that all statements contained in this application are true to the best of his knowledge and bell and that the work wdl be performed in the manner set forth in the application filed therewith. Sworn to before me this ............. day of ...... ~-~. ~ ,, ~ ~ ,// ............ : ........ ~..~........~,~...~r¢~ ................................ Notary Fublic,..Z?,..~¢~.~.~,~r~.: ,~:.,.~.,M.'.,,~0unty~ ,~7_~~ (Signature of applicant)