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Home My WebLink About3233-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~ 2654 Date ~anuary 33. 19 67 THIS CERTIFIES that the building located at ¥,0...tt.~.~. ,A.¥..~..? .................................... Street Map No. ~ ............ Block No~....~..~ ....... Lot NoX. ..~....~ ......... ~.~.~ ....................... conforms substantmally to the Apphcahon for Bumldmg Permit heretofore filed mn th~s office dated ...... ~~...~ ........... , 19 ~.. pursuant to which Bumlding Permmt No. ~.~.~..~.. dated ...... ~.~.~...~.~ .................. , 1~. .... wos ,ssued, and conforms to all of the requmrements of the applmcable prowsmons of the law The occupancy for wh)ch th~s certffmcate ms issued ms ........ n~ fa~ The certificate is issued to ~ester M. Di~erson (owner, lessee or tenu~t) o~ the u~oresmd bu~ldm~ Building lhgpector TOWN OF Sou'rHOLD BUILDING DEPARTMENT TOWN CLERK;S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL -COMPLET'ION OF THE WORK AUTHORIZED) N°. 3233 Z Dote .......................... .~ll~J:~,.J~, 19.~t.. ~ i~ermission is hereby granted to: ' · ............... -tle~ .......... !l.,/lr~, ........................ ~, ~ ..;~ .............................................. ;;. ............................ to~:.:li<~t<t.:~..raas....13azn..,,..~;~,Sa..tmil~ ................................................ ~ ......... at premises located at ........................... : .......... ~~¢~..1l.I~ ........................................................................................ pursua~¢ t6 ap~pl,[cation dated ........................ .~...~.:P.~.. ......... ..~..~. ............ , 19...~....., an,? approved by the Build~og Inspector. F. ..... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .......... Approved .........................................19 ....... Permit No .............................. D~sapproved a/c ~ ............... APPLICATION FOR BUILDING PERMIT Date ................... ~.....~..! ................. , 19...('....~... INSTRUCTIONS a. Th~s 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 buddings on premises, relahonship to adjoining premises or public streets c areas, and giving o detailed descriphon of layout of propercymust be drawn on the diagram which is parC of this applicatio~ c. The work covered by this application may not be commenced before issuance of Budding Permit. d. Upon approval of this apphcahon, the Budding Inspector wdl issue o Building Permit to the applicant. Suc permit shall be kept on the premises available for inspection throughout the progress of the work. e No budding shall be occupied or used in whole or ~n parC For any purpose whatever until a Certificate of Occupanc shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Budding Deportment for the ,ssuance of a Budding Permit pursuant to tk Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances , Regulohons, for the censtruction of buildings, additions or alterations, or for removal or demolition, as herein describe, The apphcant agrees to comply w~th all applicable laws, ordinances, building code and regulahons. (Address of app 'c~nt) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde If applicant ~s 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 ............................................ Lot No: ................. Street and Number J4'..~..~. k~?. .~ .~ ..~.~ .... ...'~....~..~:': .~.~..' ;..../. ............................ Municgality 2. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a Exishng use and occupancy ............................................................................................................................ b Intended use and occupancy ................ '~' --~..~.....~.....?~' .................................................................... 3. Nature of work (check which applicable). New Budding ................. Addit,on .................. Alteration ................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4. Est,mated Cost / O~ ~-~-'~ (to be pa~d on f,hng this applicat,on) 5. If dwelhng, number of dwelling units ............................ Number of dwelling units on each floor .......................... If garage, number of cars .......................................................................................................................................... 6. If bus,ness, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. D~mens~ons of ex~sting structures, ~f any: Front .........................Rear .......................... Depth .......................... Height ........................... Number of Stones ............................................................................................................. D,mens~ons of same structure with alterations or additions. Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8 D,mensions of entire new construct,on' Front ......... ..~..~.~..] .......... Rear ..... ?.~....~..~. ........... Depth ..~./...?~ ................ Height ! "-~ Number of Stones 9 S~ze of lot Front .......~.: ....... ~.~.... Rear ............................ Depth ................................ 10 Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. Zone or use d~stnct m which premises ore s~tuoted ............................................................................................... 12 Does proposed construction wolote any zomna law, tordmance or regulation? ..................................................... 13. Name of Owner of prem,ses ..~/...P.~..~z...~...~...~.~'.~.*-.~...Address ............ ~'.~;~z..~.: .............. Phone No ................... Name of Architect ......................................... ;~ ........... Address ............................................ Phone No ................... Name of Contractor .................................................... Address ............................................ Phone No ................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fro, property hnes. Give street and block numbers or description according to deed, and show street names and ind~cd whether ~nterior or corner lot. STATE OF NEW~O~I~'~ ,.,/~ (Nome of indi¥iduol sigmng application) above named. He is the .......... ~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and f th~s application, that all statements contained in this apphcat~on are true to the best of his knowledge and beh and that the work wdl be performed in the manner set forth Jn the apphcat~on filed therewith. Sworn to before me th~s ......... ~.....C. ......... ~~ ~ '":day'°f ~..,~, ~LD ~ ~ ~e c. ~'*' '~ ......................................... : ......... ~ ...........