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Home My WebLink About2669-zFOR~M~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPART,~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the buildmg located at~/'S./' ;De]~....Latle.i¢,~..~o~ue ........ Street Map No ..... ~ ........ Block No '"~t~ ....... Lot No ...........~ ............................................... conforms substanhally to the Apphcahon for Building Permit heretofore filed m this office dated ........................................ I~l;r~'h .3:'3 ...... , 19 ~5 pursuant to which Build,ng Permit N~26~,9"Z, ....... dated ....................I~r¢---~ "3.'3 .... , 1965 ....was ~ssued, and conforms to all of the requJrements of the appli'cable provisions of the law The occupancy for which th~s cerhficate is issued ~s ....... The cerh,flcate is ~ssued to .....M~e,...An~,~Ite..S.lag~.; .................................. . ............................ ~ towner, essee or tenant) of the ctforesa~d building. Bu~ldmg Inspector FORM 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? 2669 Z Date .......................... JJlta~i~.....]~3 ............ , 19.(~.. Permission is hereby granted to' ....... l~m...~,%~a~.~_~ll~ .................................. ..................... ~:~t~hog~, ..................................... to J~,~-%d...ai~.. a~d-~.t,-~r~..o~., m-,-. ~,4[.s~:~n~..d~e-~t~j: .......................................................... at premises located at .~....[jej:~..][,~ ........................................................................................ ................................................... ~ut~ei~og~e ................................................................................... pursuont to application doted ......................... ~,Z'g]ll......~. .............. 19~...., and approved by the Building Inspector Fee $....~*,.J]~ .......... FOI~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved ................ ~..~. .................... , 19 ........ Permit No ................................. Disapproved o/c .............................................................................................. ............................ i' Ji ................................. Application No. I~......~....~.../~.. ....... APPLICATION FOR BUILDING PERMIT Date ........................... ~..~..~,.9..~.....~ ............ , 19.,.6.~.... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildir 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 applicatic 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. 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 m whole or m pa rt For any purpose whatever until a Certificate of Occupan 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 tl Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regutatmns, 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, budding code and regulations. ..~to~e..~]~§a .............................................................. (Signature of applicant, or name, if a corporation) ....... · Dapat..&an~ ....... ~u.t~h~g~e ................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build~ ................................ .A. F~c~.t... ~.f....o.~ r ................... ~..~ .............................................. Name of owner of premises ...... ~[r.$..~Jltoz~e..~l~g~. ..................................................................................................... If applicant ,s a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on wh,ch proposed work will be done. Map No' . ..... ~, ....... H2'..Z ....... Y~..~..~..... Lot No: ..... Y~ ....... Street and Number ~.~....D. fttlO.$...l~%t't.e ..(~.~.C]B.O.g.U,~. .............................................................................. Mumcipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a Ex,sting use and occupancy ....... .d..w....e..1..1..$.tn~ ..................................................................................................... b Intended use and occupancy ............ [~. ............ .~.../.....~.~.~.J:.&$.o...~. ........................................................................ 3 Nature of work (check which applicable): New Building .................. Addihon ..~W. ........ Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Estimated Cost ......... 2.~O~..~P,/.I~. ............................... Fee ................. ~,Q.Q ............................................................. (to be pa,d on filing thru application) 5. If dwelhng, number of dwelling units ..o. rte ................... 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 ex,sting structures, if any: Front .......................... Rear .......................... Depth .......................... Height ............................ Number of Stories ............................................................................................................. D,mensions of same structure with alterations or additions: Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construction: Front ..... lj..%~6. ............. Rear ....... 1.%-.6. ........... Depth .3~:3 ............... Height ............................ Number of Stories ..... D/la ................ 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10 Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. Zone or use district in which premises are mtuated ..... !!~,:!...QllS.%. ...................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulotionP ........... rid ..................................... 13. Name of Owner of premises .... t.%~.s..J~.....S].e, ga ....... Address ...... Q.~I.%D~O~I~e. ................. Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor .... }'Ic;.Q~.,f'.a:~. .......................... Address ............. .¢.I,I~.O.b,D~.'U,~ ......... 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 descript,on according to deed, and show street names and ,ndica whether interior or corner lot. f STATE OF NEW YORK, ~ COUNTY OF .~f£nlk ............. f S.S. ......................... ~ri.t;.qD.f,...~t~.~f~ ........................................... being duly sworn, deposes and says that he is the applic¢ (Name of individual signing application) above named. He is the ............. ~.g;an~..oZ...~wrt~le ...................................................................................................... (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 th~s apphcat,on; that all statements contained in this application are true to the best of his knowledge and bali and that the work will be performed in the' manner set forth in the apphcation filed therewith. Sworn to before me this ................ .... of ......................... -,,,, , ~ ~,f~. ~/' ~,.,,~,~,~?-~ ,, .... ,?:.~.'~:..:..~.Z:...~~.~..~ ....................... Notary Public/J.j.~.......~L:...v..~O..~6,R~:~%i,q~/¢', , ~, ~,-< (Signature of appllc(fnt)