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Home My WebLink About2709-zFORUM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .......... ~--.;~,9~, .... Dote .................... ~Q~.~J~....2...3. ......... , 19..6..5.... THIS CERTIFIES that the building located at ...~;I,l:t..[,~il.e,,..~O. UfC~tf)~,~ ....................... Street Map Nh~y..i~a,lze~.... Block No...X~Q[~, ..... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office doted ........................................ J~pZ:;I. 1 ..~L4 ...... , 19..65.. pursuant to which Building Permit No. ~7..Qc~. .... dated ............................ Ap,~.~.~..'l 5 ........ , 19...6,,~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ PuT ........................................ .......................................... The certificate is issued to ..... ae,l. en..&....~.oapJ.a~L[ ...................................................... (owner, lessee or tenant) ................ of the aforesaid building. FOI~M BIO. 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? 2709 z Permission is hereby granted to: ...He.l.en..~ ... ~.o~p~.s~ ................................... ............. Gin-Lane ............................................... .................... · Ba~..l~ave~r....~eu~e]~l ........... to ............. B~ .id.. ~n...add ~.~.~..orf ..an.' e~c~ ~.ng.. ~t~et'~}.r~ ............................................. at premises located at ....... ~/R..~:~I..L~'I~t ......... ~l.~....Tla~/.el~ ....................................................... ......................................................... .s...o.~ .t.~..o..z. ~. k.~.~ .~ ,. ........................................................................ pursuant to application dated .................................. ,~.p~;~. ....... .'Ii+.., 19...(~, and approved by the Building Inspector Fee $ ...... ~.e.O0...~. ~ NO. 1 TOWN Ol: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exam,,ed " ' Approved ......~ ................................. , 19....~...Permit No ........ Disapproved a/c .................. ~ .......................................................... ......................... ................................. APPLICATION FOR BUILDING PERMIT Date ........................ ~]D~.~I, .. ,~.~ ................ , 19.....~... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn on the diagram which ds part of this application. 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. Such 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 Occupancy 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............................................... QWX~/~. ..................................................... ......~ ....................................................... Name of owner of premises ........ ..~.~i~..D.,...~.O~..~..s.~.! .................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Poslois il Location of land on which proposed work will be done. Map No: ....... BA¥../-Ia.v.~u. ............... Lot No: 6 and 7 Street and Number .................... ~i/1..T.nrze~...S~u~/lo3. d. ................. ~ ................................................... /~ c9 ~ ~./ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............... .ql,.w..f~,~,,~p,~[ ................................................................................................ b. Intended use and occupancy ............. fJ.~l~R.C~J~..g.i~.3~.g.~ ............................................................................... 3. Nature of work (check which applicable): New Building .................. Addition ...... ~, ......... Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ........$5.0D. .......................................... Fee .....:~.~.,..Q.0. .......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars .....On~ ............................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ..,,~D.~ .................Rear .~.Q.'. .................. Depth2..5..'....~..0.~'. ............. Height ..... ~.~. .................. Number of Stones ........................................................ ii ..................................................... Dimensions of same structure with alterations or additions: Front ...... G3.!.....~. ............. Rear ..... G3.! ..................... ..... ~5 .................... Number of Stories ........................................ Depth ........ 29.!...~.'.'. ....... Height ' 8. Dimensions of entire new construction: Front ............................Rear ....... ~ .................... Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: FrontLGO.! .................... Rear ............ ,~Q.0.! ....... Depth ............... ~.5..Q.'. ........ 10. Date of Purchase ..Dec~mher.,...195.8 .................... Name of Former Owner ..~.~...~..~...~.~,..~..e...Z.~..~. ...................... 11. Zone or use district in which premises are s~tuated ................ A.....~.s,~dff~,l,5~,. .............................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ,~.g. .......................................... 13. Name of Owner of premises .~.~,.~..~.~,S~.~,.....Address ....~.~Tk..~.,...~.9.q..~.~.~.~C~hone No; .................... Name of Architect ...................................................... Address ............................ ................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate early and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from street and block numbers or description according to deed, and show street names and indicate property whether inter lot. STATE OF NEW YORK, COUNTY OF .~-£fDl]c ............. ~ S.S. .......... Re.].e~..P~s~isd.1 ....................................being duly sworn, deposes ond soys thor he is the opplicont (Nome of individuo s gn ng opp cot on) obove ~med.~e is the ....................... ~ ...................................................................................................................... (Confroctor, ogent, co~orote officer, etc.) of s~id owner or owners, ond is duly outhorized to perform or hove performed the sold work ond to moke ond file this opp cotion; thor oll stotements contained in this ~pplicotion ore true to the best of ~is knowledge ond belief; ond thor the work will be performed in the monner set forth n the oppl cot on f led therew th. Sworn to before me this Publi~./~...~.~...~.... ~: ' ,,~ Signa~re of appli~ t) Nota~