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Home My WebLink About3053-zFORM I~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTM£NT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE DF DCCUPANCY No. Z 2589 Date .... 0~..t..O..l~..~...2.?.~. ........... 19.6.6. TI~IS ~l~RTIFIES that the building located at ... 0.r..~.h.~..~.d..D.~.I.v..~ ........... Street Map No..~.~S Block No...~ ...... Lo~ No ~rt ~ 1~ ~d t9, a~st ~rion conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... .A.p..~.l.1.. dated ............... ~'~[~1, .],.~ 19.(;6., was issued, and conforms to all of the require- ments .of the applicable provisions of the law. The o,ccupancy 5or which this certificate is addition to su~er issued is ............................................................................... The certificate is issued to . ...A~...i.~...~a..~.t~.l[.~.cj ......................................... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......................................... Building Inspectorff F~I~M ~0. ~ 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) NV 3053 Z rate ............... .~.~ .............. ~,. ............ , ~9~... Permission is hereby granted to: l~'.~.~....~.r.~..~..¢,~....l~u~ ........... ................ O~.m~x~r.~ .......................................... to ...hu,~l.d...m~..~ld&t,t,o~..on..~a~..~A,~t, tng..d.~®~,3,ta~ ....................................................... at premises located at ...{J~l~l'i~$..J~,~'...~$1,f~..~.....~..l~,~;..~l,~..&.-.~.O-j...~[~ ....................... .................... W/.~.....O.].d...OZ'joh'}d..~ ................. ]~l.'C....~n ............................................... pursuant to application doted ................................ AI~..].......'I..~ ........ 19.66.. and approved by the Building Inspector Fee $...~.QO ........... Building Inspector FOBM NO. I Examined ...x~....:~)..-~..~:. !..~ ~ ........... , Approved .................................... , TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. " Z-- 19 ........ Permit No ................................. Application No......-~....0..?'~.._~.. ............ APPLICATION FOR BUILDING PERMIT .................... , 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 property must be drawn on the diagram which is part of this location. 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 whol~ or in part for any purpose whatever until o 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, ordina~n~es and regulations. /~ (Signature of applicant, or name, if. a corporation) ......................... of ......... 1] ....... State whether ao_[,)licant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................... ...................................................................................................................................... Nome of owner of premises...~..~......~..~.....¢~.....I..¢,~......V..~.~1'.~,~.~.~.'~....~...(~ .................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed w~, will be done. Map No: ....... ...~......~... ......................... Lot No: ...... ..~...~'... Street and Number""~ ~ '~ '"" ~-¢,,~.~lJ~0....~...~...~..E~...~..'..~...~...~...~...~..`.~...~.....~........~....~..~.~.~.~...m.~.~)..~..`'''' Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ...~.~....¢~.....f~...~....~.....~..~..~....C~. ....................................................... b. Intended use and occupancy ..~...~.....~).~..~ property lines. Give street and block numbers or description according to deed, whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition..../~ .......... Alteration .................. Repair ........... ...~.... Removal .................... Demolition .......... :~.. Other Work (Describe) .................... 4. Estimated Cost'~....~'~.~....~...O...'..~...~. ........................ Fee ...............~_'....:..O...O. ............................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ......... L ............... Number of dweIling units on each floor .................................. If garage, number of cars ....... ~,~.i~.ll~..~ .................................................................................................................. 6. If business, commercial or mixed occupancy, specif,v/ncjture and extent o,f~aqh type of use ................. 1 .............. 7. Dimensions of e~xisting structures, if any: Front........~...~....~ ....... Rear .......~...~.......'. ......... Depth .....~.....~... ................. Height ...... (~ ................. Number of Stories ....... I .......................................... ~ ....................................... I ................. t t' t t or t n Fr nt ~ ..~... Dimensions of same struc ure wi n a era icuns add' 'o s: o ............................... Kear ............................... Depth ...... ...~....~ ................ Height ../..5.~ ./'. ---- Number of Stories, 8. Dimensions of.en~ti~e new constructi~'~': Front'iiiii~.~.il ............ Rear ..... ~i'.~..'.iiiiiii'.iiii"'1~'~".~ ................. Height ........... !...~.. ........... Nurgber of Stories ......... I.... .................. 9. Size of lot: Front ........ ~ ........... Rear .....&..~.. ...............Depth ...... ...... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated .................................................... ~ ............................................. 12. Does proposed construction violate an,/ zoning I~w, ordinance or regulation? ....... ~.~__~..~'. .................................... Name of Owner of remisesQ ~ [~J~JUJJl~(~AddressUj~r~- 1~(7--~1~O "Lli~ne N 13. p .... :.....: ............................ ~ ............................ O ..................... Name of Architect ................................................... Address '~-'~'1~'.~'"' Phone NO ..................... Name of Contractor ..~...'......~...,....~...Q.~..O..~. ........ Address i~i~ .............................. Phone NC~'.~..,.~...~..!....(~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from and show street names and indicate STATE OF NEW/YO,RI~ ) S S ,~' , COUIxJ/FY OF ~ ........... ) ' ',, .... ;~,~.~ .......... .......Z~~ ........... being duly sworn, deposes and says that he is the applicant (Name of individual signing above named. He is the ......... ~.-~ ~,~...~ .. .~ ................................................................................................................ (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 file this application; that ail statements contained in this application are true to the best of his knowledge and belief; and that the work w I be performed in tb~n~c ~t f0r}h in the application filed therewit~ Sworn to be~ore me th.s No. ...... ~...~ ........... day of ...'..'~..~.,~ ............... 19...~.....;. ' Notary Public, ..~i~[]¢;~Z2L~¢.;~7.?.ff.':;~Count~¢~/. (Signature of applicant)