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Home My WebLink About3286-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...~..26~3 .......... Date ............. Aj~il..24 ...................... , 19..l~t. THIS CERTIFIES that the building located at . ~t~l~t~l~ .J~'~..~i~J~ ........................ Street Mop No .... ~ ....... Block No ..... :IQQQ[ ...... Lot No ........ ~ ........... .8otlt,~o,l,d-,...l~L..Y ....... conforms substanhally to the Apphcation for Building Permit heretofore filed ~n this office dated ........................... O~c)]J~llkTC ..~4.... , 19...~6 pursuant to which Building Permit No..~J~t. ~ dated ................... ~OJ:~'...2~ ....... , 19....J~6 was issued, and conforms to oil of the requirements of the applicable prows~ons of the law. The occupancy for which th,s cert,ficate ,s ,ssued ~s ....... ................. add~.~.~.~..t~..~n~. ~am&l~:. d~elXJ~r~ ................................................................. The certificate is ,ssued to .......~....~..elAt~,..~J~l'~l.~'~V ................................................................. (owner, lessee or tenant) of the aforesmd building TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, FI. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL ,COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: to' .~l.3.~..~..~~.~....~_~a.t~l~l,~...~..~t~.~s,~L.~l~l,.M~ ............... at premises Ioca/ted at ..... ~..--~ll..~ll~ ..llall~J, .................................. .; ............................. ............................................ ll~t,t~: ...... I!,'~ .................................................... : ......................... pur~uor~t to ap~plication dated .: ................ ; ...... : ...... ~ ......... ~ ...... , 19. J~., and approved by the Building Inspector. Fee $.-~e(]~ ............ FOI~M[ NO. ! TOWN OF SOUTHOLD · ,'ow. c,..,.'s Examined ~ ~)_ k~. 19.~.. Approved ....................................... , 19 ........ Permit ~o ................................ C ........ ..... ......................... ~.~;~ ................................. Application No. ~:) ~ ~-- (o ^P~UC^T~ON FOG SU:LD~NG ~E~M~V Date ................... ..~?r~.......~...../~'.. ................... , 19~.....~. ...... INSTRUCTIONS a This oppficotion 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 buddings on premises, relationship to adjoining premises or public streets or areas, and gwmg a detaded description of layout of propertymust be drawn on the d~agram which is port of this application c The work covered by this apphcotion may not be commenced before issuance of Budding Permit. d. Upon approval of this opplicahon, the Building Inspector will ~ssue o Budding Permit to the applicant. Such permit shall be kept on the premises available for ~nspection throughout the progress of the work. e No budding shall be occupied or used in whole or ~n part For any purpose whatever untd a Certificate of Occupancy shall have been granted by the Budding Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the ~ssuance of o Building Permit pursuant to thc Budding Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o~ Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The apphcant agrees to comply with all opphcoble laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder ......................... .~. 4~.. ~.,.~.~.. ~.-'~, ................................................................................................................................. Name of owner of premises ..~....~..~....~..../......~..~...'~....Z~...~..~.~;~...~./;~'../....~ .................................................................... If applicant is a corporate, signature of duly authorized officer. .... .~.~..~?...~....[~..~/.c~.-/.. ~..~-. 6/. ........ ~.,~.z.~.~-/~.. (Name and htle of corporate officer} 1 Location of land on which proposed work will be done. Map No' . ........................................... Lot No: ................. Street and Number .....-?~.~..~.~-;/.../.('x;ZT.~..~..¢..~.......4:.....~...., ........... .~....q..e:/.....7~.../..-4'...~.....z...~.!.L/.~/~'. .................................. Mumcipahty 2. State existing use and occupancy of premises and ~ntended use and occupancy of proposed construction: a Exist,ng use and occupancy ../.....~..~,c~.~SAZ...4. Z.~ ~ ,~'..~.~- ~-/x/ .~. - .. b, Intended use and occupancy .............................. .O~..../~...,.z~..,,../~.'~.. ............................................................................ 3. Nature of work (check which applicable): New Building .................. Addition ...../¢~.... ....... Alteration .............. Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................. 4 Estimated Cost ..........~r...~ ..................................... Fee ...................................................................................... (to be paid on fihng th~s application) 5. if dwelhng, 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. D,menstons of ex~sting structures, ~f any. Front ....~...¢~...~. ............. Rear .....~...~...] .............. Depth ..¢~....~...( ............... Height ..../.~'.../. ................ Number of Stones ..... ../. .................................................................................................... D~mens~ons of same structure w~th alterations or additions' Front ..... ¢..~.~ .................... Rear ...'~,~..~.. .................... Depth .....,~...,¢. .................. Height ..../.~'. .................... Number of Stories ...... ~. ............................... 8 D~mensions of entire new construction: Front ............................Rear ............................ Depth .......................... Height ............................ Number of Stones ............................ 9 Size of lot: Front ............................ Rear ............................ Depth ................................ 10 Date of Purchase ........../..,¢...~....f. .............................. Name of Former Owner ..,~...~..¢_...¢...~../.~..~.~.~!..:...~.,4'..~.. ............ 1 1 Zone or use district m which premises are situated ......... .~...¢~..-~¢../.'.~...4T~..2?;..C,;/:C.....z-~.. .............................................. 12. Does proposed construcbon violate any zoning law, ordinance or regulation? ...¢21...¢....; ....................................... 13. Name of Owner of prem,ses .~.....~',..../~/....~...,~...zZ....~..~..,~....~...~.~.Address ...~.~..~...~...*~.....~..~...,~. ...... .'~..¢/¢... Phone No ................... Name of Architect ...................................................... Address ............................................ Phone No ................... Name of Contractor .,~....~.~-~',.~¢'.,¢~...~......?.4...~.Z?..~..C.E..~..4..~ldress ....v~...c..~..?~....~(z..~...Z.r.~-~. .......... Phone No.~..£...d~.'...~..?..3... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and Indicate all set-back dimensions fror property lines. Give street and block numbers or description according to deed, and show street names and indtcat whether interior or carnet lot. STATE OF NEW YORK, S.S. COUNTY OF .............................. .......... ~z~.....¢~.../..../~.. ..... ...~.,....f../...c....~2'.....~../....~...~....~.....~... .................. be,ng duly sworn, deposes and says that he ,s the applicon (Name of individual s~gmng application) above named. He is the .......... ~....~.../....z.....,~.....~..../~:... ............................................................................................................... (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 th~s apphcation, that all statements contained in th~s application ore true to the best of his knowledge and belie~ and that the work w~ll be performed in the manner set forth ~n the apphcotion f~led therewith. ....................... .... ...................... Notary Pubhc, ../'..~~¢~ounty~c~z:Sj (S,gnature of applicant)