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Home My WebLink About3251-zFO~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the build,ng located at .~..J~..~.O.l't.'l.~.. Jl..a.~....~..~.~.d.. ...................... Street Map No .~ ........ Block No ...~ ...... Lot No .... ~ ........... ...l~....~..t...~.~.l~.~..~.¢....~....~......Y.O~k conforms substantially to the AppJicohon for Budding Permit heretofore filed in this office doted ...................................... ~t,101~:~liJ,1~..,~ , 19 ~6 pursuant to which Bu,Jd,ng Permit No . .~..~..~.~'...~... dated ................................ ...O~..tr.~...lJ~...~.....~.., 19....6..6.., was ~ssued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for which th,s cert,ficate ~s issued is ........ .......... .~.d..$~.o~...to..orxe.,.~.~.., ~,~ ~.~r~ce, .................................................................. The certificate is issued to ..... ...J~...~...~...~..[.'~?~.!...~..~..*. ......................................................................... (owner, lessee or tenant) of the aforesaid building Budding Inspector (/" FORM NO. 2 TOWN OP 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? 325 Z Permission is hereby granted to: HoI[. ~ea~e&..Sona..~....~.~....Ifo../aZse~ 8r ................. Ile,.t,.t :Lt,.g,ek ......................................... at premises located at .......J~OJ~.;J~i,~t...~,~lJ ............................................................................... ................................................ lf~.~.~,.tmek ~ .....lt, ~C A .......................................................................... pursuan,t to application dated ....... ~'. ............... O~.t .......... ~ ................. , 19...6~, and approved by the BuiJdJng Inspector. Fee $...5~.~. ........... Building Inspect~ ........ ( ' FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~ "~ 6 ~ -' ,, Z._ Approved ........................................ , 19 ........ Permit No ............................. Application No ............................. 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 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 Departm'ent 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 andregulations, z (Signature of applicant, or name, if a corporation) · ............................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ............ ~4z. ~. ~'~...¢.. ~o...~... ~ ....................................................... Name of owner of premises ..... .~..~.Z.~.~.~/~,.~.~..y:...J~/~.,,. ................................................................................. If appl~nt is a corp~,,ate, signature of duly authorized officer. ...... (Name and title of corpGrate officer) 1. Location of land on which proposed work will be done.~...~.Z.~..~..~...(...~..~...~--~.~',~.....~..~L~...~...~...~......~...~.~..7' .......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ,~r/.~,~.~/.~?.~Z./~..~.~.. ................................................................................ b. Intended use and occupancy ........ ~..~.J'/.~4~.~_- ...................................................................................... 3. Nature of work (check which applicable): New Building";[L ............... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition. ................ ; Other Work (Describe) ........................................ 4. Estimated Cost ........................................... . .......... i.....Fee .......................................................................................... (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 ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ........... -~ '-/-,~ '~'"": .......... Rear ............................... ,~ 5/~. ~" Depth...,~.~.....o...,/,2 ~ · Height .., ........ ~ ....... ...,.. Number of Stories .......... ~ .................................................................................................. Dimensions ~f same structure w~th .) olterahons or a~'J'i~,ons: Front ................................... Rear -~1"~i'~'~_' .......... Del~th ........ ~ ........... :y ....... Height ............................ Number of Stories ...... ~,~ ...................... 8. Dimensions o~enhre new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. S ze of lot Front .......... v .............. / Rear ................... ~..,/ .......... Depth .......................... 10.. ua~e ol' vurcnase ................................................ : ....... Name ot I-ormer Ortner ..,~......~ .......~/ ......... ~,~, ................. Zone or use district in whi~h,~rem~ses are situated .............................................. ~' ...................................................... 1'~:. Does'~reposed const'~u~io~ v~late: ~y ~n~ law, ordinance or reaulat~on? ....~.~ ............................................ 13. Name of Owner of premises ~.y~.....~ ...... ~ ....... ~..~....Address ..~2 ....................... ~.: ........... Phone No ..................... Name of ArchJt~t ..................~ ..................... ~ ............ A~ress ............................................ P~ne No ..................... Name of Contractor~ ~ ~'1'~"% ........... 4'~"~'"'"'~'~, ~j~.j..~...A~ress ....... ~./x/~//Z{~;~ ................................. ' ' PI-aT DIAG~M ~ate cl~rly a~ distJ~tly al! ~i~ings~ w~th~ existing or pr~, a~ indi~ate oil ~ dJm~si~ from prope~ lines. Give street ~d bilk numar or de~rJption a~rding to d~, md ~ow ~treet nam~ and indicate whether interior or comer (~ame of individuoJ sigrimg appli~:otion) ':above named. He is the ......................................................................... (Contractor, agent, corporat~ of icer, etc.) ~ bT~aid owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge andbelief; and that the work will be performed in the mahner set forth in the application filed therewith. Sworn_ to before me this ~ ~ ' . __ 19..~...~... ....... ....... ................ ! · ...... ..................... .o.o 0, ,,. x , - v NO. 52-8177780 / Rlll~llrlj Itl Suffolk Count~ ~tl~l~i~r~ Expires March 30, JgI~o~