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Home My WebLink About2651-zFO~M NO, 4 TOWN OFSOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No ,~...~32~ ............ Date ........................ ~.e..~...~..~..e.,.~.....~.~., 19 .,~..~. THIS CERTIFIES that the building located at .O'z'(~]3,&]~.CL.&..~J.~..S.~ ........................ Street Map No ...:~. ........... Block No ...... ~ ......... Lot No]~.. .......... ~.e..~...,.~.~.~...O,.]:.,~.L..~.?...~.~ ............... conforms substantially to the Apphcotion for Buddmg Permit heretofore filed in this office dated ................................... ..]~.~.~ ..3... , 1~.... pursuant to which Building Permit No. dated ................................ ~..~..~....~., 19.~ .~..., was ,ssued, and conforms to all of the requirements of the applicable prowsions of the law The occupancy for wh,ch th~s certificate ,s ,ssued ,s ..... . ~z'.i~a~.e.. ~n~..f~ ly...dwelltn~ ......................................................................................... The certificate ~s issued to ...~[~8,]~,...0~{3.g],~ ................ 0Te'~:~. ...................................................... (owner, lessee or tenant) of the aforesaid buildmg Building Inspector /- 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? 2651 z Permission is hereby granted to: ...... ~.~.~...~ .............................................. ........... .~..~p.~.~ .......................................... at premises located at ....~....~1~...~...~..~...~...¢~.~...~. ~.~...~.~ ................................................................... ....... .,.~.." ...................... ~..,.?....~.~?.~..~., ..... ~:.~, ............................................................................ pursuant to application dated ......................... ~.~...~......~. ................. 19.....~.~, and approved by the Budding Inspector $ 10o00 Fee .......... ~ ............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ..... ....... Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c .... ~~~ ....................... (Building ~lnspector) Application No. ~.,~./',. ............. APPLICATION FOR BUILDING PERMIT Date .......................... .~..~:~.¢.~....3 ............... , 19..0..~.... INSTRUCTIONS o. Th~s application must be completely filled m by typewriter or ~n ink and submitted in duplicate to the Buildi~ Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giwng a detaded description of layout of propertymust be drawn on the diagram which is part of this applicotio c. The work covered by this application may not be commenced before issuance of Building Permit. d Upon approval of this applicahon, the Building Inspector wdl 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 pa rt For any purpose whatever untda Certificate of Occupan. shall have been granted by the Bu,ld~ng Inspector APPLICATION IS HEREBY MADE' to the Building Department for the issuance of a Budding Permit pursuant to Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Reguloh9ns, for the construction of buddings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with oil apphcable laws, ord,nances, building code and regulations. (S,gnature of, applicant, or naT/~i'f-~corporot,on) ............ ......................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or buildc o~e~ .... Name of owner of premises ..... ..C..]:..~...~..~.....0.~.o.~. ................................................................................................................. If applicant ~s a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will be done. Map No' . ............ ~ .....................Lot No: ....... .~....~..... Street and Number ...g~.ci:~t,..D.t:,..~c..~ec~oT~]...~.~.t ...... }ie.~..~f'J~P~:.t...~,.~., ............................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..QE[Cl...~L~Ce~L],~'~g....~O...~e..~.e~,O~.ec] .............................................................. b. Intended use and occupancy .... ~(~..O~G..f'aJTJ::]..'L~...C].~.~.-L~J.Z~ ................................................................. 3 Nature of work (check which applicable): New Budding ~ ....... Addition .................. Alteration ................. Repair .................... Removal .... ~ ........ Demolition .................... Other Work (Describe) ..................................... 4. Eshmated Cost .... .c).t.~.Qg...~/l~J. ................................. Fee ........ ~.O. ............................................................................ (to be paid on filing this application) 5. If dwelhng, number of dwelling units ...Qlg,~ ................... Number of dwelling units on each floor ........................... If garage, number of cars ....Q1%e ................................................................................................................................ 6. If bus~ness, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D~mensions of existing structures, if any: Front ..........................Rear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................. D~mens~ons of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ....32 .................... Rear ............ 32 ........... Depth .............. ~ ....... Height ............................ Number of Stories ..... .qD.e ................ 9. Size of lot: Front ..,~Q. .................... Rear ........... .6..0. ............ Depth ......,1...0.~ ................... 10. Date of Purchase ...... 19.63 ......................................... Nome of Former Owner ......~....a...t~......g..,a:.~...s..o..~.. ..................... 11. Zone or use d~strict in which premises are s~tuated ........ ~ ....... d;Ls.~ ........................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ................ hQ ................................ 13. Name of Owner of premises g.~.~..~...g.~g.~... .............Address ...~..e...~.....~...~.~..~.°...~..k, ................ Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor Et~e~e..~oz'J;~n ..................... Address ......... ]?~l~.~.~.g,~ ............. Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro, property lines. Give street and block numbers or descnpt~on according to deed, and show street names and ind~ca whether interior or corner lot. STATE NEW YORK~ COUNTY OF ..~.l~.fo.l~ ........... S.S. ..................... .C...~.~,~.fL..Qt'g,g.~. ................................................. be,ng duly sworn, deposes and says that he is the applio (Name of ,nd,vidual signing application) above named. He is the ....... o.~e~'. ................................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and this opphcotion; that all statements contained in this application are true ta the best of his knowledge and bell and that the work wdl be perfo~ed in the manger s~$~r~h in the application filed therewith. Sworn to before me this C u .................... Z... do~ of ................ ~.~ ......... Noto~ Public, .~.~~~./' - ' ~~