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Home My WebLink About3261-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .~..265~i. ........... Date ...............Jl~ll~,r¥..3 ~ ..........., 19~?.... THIS CERTIFIES that the budding located at T~/~ M~,I~t)~t A%tl~ ........................ Street Map No .... ~ ......... Block No ....... ~ ...... Lot No ..:)(~1~ ................. (:~l~O=tr, .............. conforms substanhally to the Application for Budding Permit heretofore filed ~n this office dated ....... O~bo,l~'...l~ ....................... , 19 66 pursuant to which Budding Permit No. dated ...... OCt, O)~,IC...I.1 ....................... , 19. 6.6, was issued, and conforms to all of the requl rements of the applicable provisions of the law The occupancy for which th~s certificate is ~ssued is ........ ........... il.to~&g~,..hua~r~J~ ·..I~I~L J~,~g· The certificate is issued to ..S.t~/::l~ .J~d~,.l~J~,,~l~,~.,.,,~Kl-~ ............................................... (owner, lessee or ten,ant) of the aforesaid building Building I n~ectorx---~ FOF,.~[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN G~ERK'$ OFFICE ~SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ,[~'O. 32J~1 Z ~ Dote ........... Permission is hereby granted to: at premises located at ...~.j.....jIJI~ItI~L~..~i,*IHIII .................................................................. [~ .......... ........................... ................................................................................................. pursuant to application dated ......................... (J~i....~ .................. ; 19.1~.., and approved by the Building Inspector. JJ~lJ! J~tl~Je~ ~ (ItilEe%~ eOll~L~J/~%J tlr[t~ JatiJ~%' ~ll~Jt~ lkwl~etle Fee $...~..,O..e.. ,.~.. .......... ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ...... ~.....J....[ ....... , 19..~....~.. Z Approved ....................................... , ]~ ........ Permit No .....................':... Dlsapp roved a/c ~~..~ ...... ............................... ................................. Application No. ~ ~- (' j' APPLICATION FOR BUILDING PERMIT Date ........................ .g.~.~.Q]~.~J~.....,~l ......... , 19..~.~. .... INSTRUCTIONS a. Th~s application must be completely filled in by typewnter 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 adlmmng premises or public streets o areas, and g~wng a detailed description of layout of propertymust be drawn on the &agram which is part of this application c. The work covered by th~s apphcat~on may not be commenced before ~ssuance of Building Permit. d. Upon approval of this apphcahon, the Building Inspector will issue a Building Permit to the applicant. SucJ permit shall be kept on the premises avadable for inspection throughout the progress of the work. e No building shall be occupied or used m whole or m part For any purpose whatever until a Certificate of Occupanc' shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Budding Permit pursuant to th Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulahons, for the censtruct~on of buildings, additions or alterations, or for removal or demolition, as herein described The apphcant agrees to comply w~th all applicable laws, ordinances, budding code and regulations. (Signature of applicant, or name, Jf a corporation) (Address of applicant) State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electnc~an, plumber or builde~ ........................................................ ............................................................................................................................ Name of owner of premises ...~..%.~.U::I,j,:p~ ~T~.~C~,17.. ~'~kDa,..,T, rk¢ ....................................................................... 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 ......~//S....k~az~lx~n.~e.~..~=e .......... ~ze~r~oz'.t; .................................................................... Mummpality 2. State ex~stmg use and occupancy of premises and intended use and occupancy of proposed construction: a Ex~sting use and occupancy ..... ~.~;:l,]p.~EkU~ ..~...~-.~. .................................................................................. b Intended use and occupancy ...... .~.~....Ln:..e....'w.':~.~.~..~...~..~..~...~''8..J~.e.....(.b..'1r1:.'~.~.:~...r}.~.~.).~.~.~ ............................. 3. Nature of work (check which applicable): New Budding ..... ~ .... Addition .................. Alteration ................ Repair .................... Removal .................... Demohtion .................... Other Work (Describe) .................................... 4. Eshmated Cost ......... ~.~.80.0..~.,Z.~ ............................. Fee ..... ~D .............................................................................. (to be paid on filing this application) 5. If dwelhng, number of dwelhng units ..Z].a_r~ ................ Number of dwelling umts on each floor .......................... If garage, number of cars ......................................................................................................................................... 6 If bus~ness, commercial or mixed occupancy, specdy nature and extent of each type of use .......... 7 Dm~ens~ons of ex~stmg structures, if any: Front ......................... Rear .......................... Depth .......................... Height ............................ Number of Stones ............................................................................................................. D~mens~ons of same structure w~th alterahons or addmons' Front ................................ Rear .............................. Depth .............................. Height .............................. Number of Stories ........................................ 8. Dimensions of entire new construchon: Front ......... ZL0(~ ........... Rear ......... .'LO0 ............ Depth ........... 6.,~ .......... Height ........2..~.. .............. Number of Stories ..... Q:~.~ ................. 9, Size of lot. Front ............................ Rear ............................ Depth 10. Date of Purchase ........................................................ Name of Former Owner ...................................................... 11. Zone or use &strict ~n which premises are situated ....... !!.~..!!....d..~.~.i;;~.$.q.~ ........................................................... 12. Does proposed construction violate any zoning law, ordinance or regulahon? ......... 4~.Ct 13 Name of Owner of premises .~.t. ez'.l, fz].g..~b~::..JY[~ld6~...ZZ~¢ ....... G.l~ZZ.l~O.:t,.lr, ..... Phone No .................. Name of Architect ...................................................... Address ............................................ Phone No .................. Name of Contractor ..... o'w'z~e~'. .................................. Address ............................................ Phone No .................. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting 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 indica whether interior or corner lot. STATE OF NEW Y~..RK, ~ COUNTY OF ......... .~'~'.~lJ~ ........ f S.S. ............................ ~ft~.,]...~_f'~ ........................................ being duly sworn, deposes and says that he is the opplic (Name of individual signing apphcation) above named. He is the ................ ~.OZ'~ .... 0~£.-i~e~. ....... ~,~rz~z~.) ............................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and ~s duly authorized to perform or have performed the sa~d work and to make and th~s apphcation, that oil statements contained in this application are true to the best of his knowledge and bel and that the work will be performed in the manner set forth m t~opplicat~on filed therewith. . . Sworn to bef~r:e ~ t~ ~ ~ IL .................... z. y .................. ......... ' ..... ....... ............................... Nota~ Publ,c~~...~.¢...~~ ........ ~oun~' ~ Z ( g~'u e'~f~~ ~,'~]~ A r,r~ ,. ~ IAI NOTARY Pd , L , c, ,,e,~ Ym~ ' ' ~ ~