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Home My WebLink About2690-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No -..~-.;2.~[~4 .......... Date ................ Jat~u~r.~:. 2.0 ............. , 196~.. THIS CERTIFIES that the building located at ~O%'.~'t StOa~,..~.eCO~--~.C ..................... Street Map No .... ~ ........ Block No .... ~5~fX ...... Lot No .... ~ ..................................................... conforms substantially to the Apphcat~on for Building Permit heretofore filed ~n th~s office dated .............................. A~;$,~..[ ........... , 19.65 .. pursuant to which Building Permit No .2.6.cJ(Y~ .. dated .................... ~[o=.,%.~..2 ........... , 19. (i~, was ~ssued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for which this certificate ~s issued is ........ ........................... ad,~..t:l.~...to...on~.. ,g~m~lI~'.. dwe.%~ ~,~g ..................................................... The certificate ,s issued to ................... Helmta.t..Ha~s .................................................................. (owner, lessee or tenant) of the aforesaid building Building Inspector' FOFoM 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? 2690 z Permission is hereby granted to: pursuant to application dated '~ -- ...................... ...~"~......'¥m.--. ................. 19.~....F~., and approved by the Building Inspector Fee $...~.. .................. Building Inspector FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ~....~ ........ 19...~..:b' ,9 ........ Perm tNo. f Approved ' ' ' ~ Disapproved a/c .............................. ~ ..... .~ ............... ~, ............... ~ .............. ........ ................................. Application No..,~.~..;/.~'..~..~. ........ APPLICATION FOR BUILDING PERMIT Date . ~ [ rzl ~ ! 19~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buildin, Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets o areas, and gwmg a detailed descnption of layout of propertymust be drawn on the diagram which is part of this application c. The work covered by this apphcat~on 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. SucJ permit shall be kept on the premises available for inspect,on throughout the progress of the work. e No building shall be occupied or used in whole or m part ~or any purpose whatever until a Certificate of Occupancy, shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Bu,lding Deportment for the issuance of o Building Permit pursuant to th, Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ Regulations, for the construction of buildings, addmons or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. }!elmut H~ ss (Signature of applicant, or name, if a corporation) Coutno! (Address of apphcant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................... .......................................................................................................................... tlelmut Hass Name of owner of premises ..................................................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer} 1. Location of land on which proposed work will be done. Map No' . ..... Street and Number ....~. ~..~........~..O.~.~.....(].~...8..~.:l:..~.....~..O.~.~...)....g.: .~..:..~.~ .......... ?..?.?...O.,~..~..?..~.....~..:,.~..,. ........................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy d~elling b Intended use and occupancy 3. Nature of work (check whmh applicable): New Budding .................. Addihon .... ~ .... Alteration ............... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................. 4. Eshmoted Cost ....~i~O..~./~ .................................. Fee ..¢i. ................................................................................ (to be paid on filing this application) 5. If dwelhng, number of dwelling units '~l:~e ...................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 ....... .~.1}. .............. Re~r ........ '3'].' ............ Depth ...~,~,/....'t~, Height ............................ Number of Stones ...-oteze ................................................................................................. D~mens~ons of some structure with alterations or additions: Front ...~1,.~'. .......................Rear ....... ~k.~ ................. Depth .............................. Height .............................. Number of Stories ..~O~ .............................. 8. D~mensions of entire new construction: Front ...... .1.iF ................ Rear ......... ~b~ .............. Depth ...-*l-Sml.~D ......... Height ............................ Number of Stories ....... O~e .............. 9. Size of lot' Front ...... /o0' ................ Rear ............ (-O ........... Depth .....,,~ ...................... 10. Dote of Purchase ........................................................ Nome of Former Owner ..................................................... 11. Zone or use district in which premises are situated ....... tl~tt..~.~.c~c~.~ ........................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation~ ..... ?.,~ .......................................... 13. Name of Owner of premises ...i]~...JJa.~ .................... Address ........ $~¢~.I~1, ................. Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor .................... ]~,~..~[e,~,~ ............... Address ............... ~ ........................... Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~stmg or proposed, and indicate all set-back dimensions frol property hnes. Give street and block numbers or description according to deed, and show street names and indicat whether interior or corner lot. (^ STATE OF NEW YORK, COUNTY OF ..... 'S',,~£O'~ ......... ~ S.S. ............................ ~.~t~.t,..[~..~ ......................................... being duly sworn, deposes and says that he is the opplicor (Name of individual s~gning app ication) above named. He is the ............... ~e~ ..... ~.Z~e~ .................................................................................................... (Contractor, agent, co~orate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fil this application, that oil statements contained ~n this a~pli?tion are true to the best of his knowledge and belie' and that the work wdl be performed in the manner set torth in the application filed therewith. ..................... ............... ............ ..... ............. Notary Pubhc, ZJj~~....~,...~..~tCounty~?~., f,~ ~:::'(~i.9g,~ture of appl[cant) .......................... /