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Home My WebLink About3010-zFOEH NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATe OF OCCUPANCY THIS CERTIFIES that the building located ct ....... .g.~.g..}lRt~.f[..~J~l~. ................................. Street Map No ....................... Block No ....................... Lot No .......... .E..~.~...~I...~...ZJ..O.~.,...~..~.....Y..~.J:~ .......... conform~ substantially to the ,~pplication for Building Permit heretofore filed in this office dated ...................... .l~.~.=..C...h....4..~ ......................... , 19..6...6... pursuant to which Building Permit No. ,~..0.~.0.....Z.. dated ............ .~...~..~.~..~...~..!. ....................... , 19...6...6., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ........ ~.~..~.~.~e....Q.~....~m ~,~,~. ¢1w.~1~,~ ....................... The certificate is issued to ....... .M..~.]:'...~..°..rl.....~.0. cJ.~..~.~. ............................................................................... (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPArTMEnT TOWN CLERK'S aFl:ICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3010 Z Dote ........................ ~eh.--..h. ................. , 19...&6 PermissiOn is hereby granted to: ~T,... ~og~,~.,m. A/P~ ....,;,LL~n.. ,Rc~ e~ ~ ............... .............. E~z,t..~ar. ic~ ....................................... to ....T~..l~u&.~.a.~.a~..a~ta.i.~.~en...ea..an..e~.a~.n~..dwe.~:litag ............................................... et premises heated et ..,.O.~.~.~f~'~...b~. ........................................................... ~ ............................... ............................................ .~.~.~...k~.r. ;k~a~ .....~., 2~ .................................... : ..................................... pursuant to application doted ................................ ~..~...~ .............. 19.~;~.., and approved by the Building Inspector Fee $..~.*..0...0. ............. I~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .Examined .... Approved ........................... ~...~. ......... , 19....t'... Permit No..~..~.../....O...~ Disapproved a/c (Building Inspector) App,catian No..3....O....!....q ............ APPLICATION FOR BUILDING PERMIT Date .............................. ~.~..~ .e...~...... ,~. ........... , 19...6...6. ..... 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 RuNic 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 shalJ 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 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 Regu at OhS for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comp y with all applicable laws, ordinances, bui ding code and regu ations. (Signature of applicant, or name, if a corporation) ............ Ea.s~:~a~d. on. ............................................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Name of owner of premises ...~J,,],.t,.ozl..~oCe:~.s ................................................................................................................. If applicant is 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 ..Q~.D~za~'.c~..%az~e .......... ~,~B~..L~a~LO~ .................................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... ~l.~/e.].:L~L~Qg. ........................................................................................................ b. Intended use and occupancy ............... .s...~a~_.e....w...~.~..~....~.~....~..d..J,..~$~..~. ............................................................... 3. Nat: Rep~ 4. Estir 7. Hei~ Dim Dep 8. Dim 9. Siz< 10. Dai 11. Zor ' 12. DoE 13. Na~ Na~ Na~ property whether STATE OF COUNTY ~re of work (check which applicable): New Building .................. Addition .....](.~T~. · ..... Alteration ....i ............. ~ir .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ ~ated Cost .......6.00...P/.M .................................... Fee ...... ~....i ............................................................... ~ ............. (to be paid on filing this application) If d,Welhng, number of dwelling units ....... Drle .............. Number of dwelling units on each floor ............................ garage, number of If l~usiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ Dirdensions of existing structures, if any: Front ............................ Rear ................................ Depth .......... .......... ht Number of Stories ,msions of same structure with alterations or additions: Front .................................... Rear h ................................ Height ............................ Number of Stories ................................ ~nsions of entire new construction: Front ............ ~. ...................... Rear ..... .r/ .................... Depth ....... ~, ............ iht .................... Number of Stories ........ ~te ..................................................................................................... of lot: Front ............................ Rear .................................... Depth ................................ of Purchase ........................................................ Name of Former Owner .......................................... : .............. or use district in which premises ore situated ....... ~,.....~.:~.~ ............................................................................. proposed construction violate any zoning law, ordinance or regulation? ............ ~1~1. ........................................... ~e of Owner of premises .~J~.~D~..~f)~fl:~.~ ....... Address ............. ~;,,._~az'J. oz). ......... Phone No ....... ne of Architect ...................................................... Address ............................................ Phone No .......J .............. ~e of Contractor ..~8~fl~-.~.Q~.~.~.~ ...................... Address ........ .[4',,...~[L~..J, Q13 .............. Phone No ..................... PLOT DIAGRAM clearly end distinctly oil buildings, whether existing or proposed, and indicate all set-back dimensi nas. Give street and block number or description according to deed, and show street names and :erior or corner lot. NEW YORK, ~ c c DF ...~u~.~lk ........... ~' '~'~' ~ns from indicate .................................... ~'.~,~..~lg~e%'.~ ............................... being duly sworn, deposes and says that he is the ~pplicant iNome of individual signing application) above narr ed. He is the ........................ .C[~.t;z'.ac.l~. ......................................................................................... ~ .............. (Contractor, agent, corporate officer, of said owner or owners, and is duly authorized to perform or have performed the said work and to m.akej and file this applic ~tion; that all statements contained in this application are true to the best of his knowledge and belief; and that the w~rk will be performed in the manner set forth in the application filed therewith. Sworn to ;fore me this /1 . j.Lk. day of . ~ftZ'.Ct~ , 19 6~. ................ , ..... ......... '7,; ", ................ ........... Notary Public, ~.~'..~....(~..:..d.~County / (Signature of afp'plicant) I f/ MARION A. REGENT -- ",~OTARY PUBLIR, State of tlew York : No. 52-S233120 SuNolk County I Term Exphos March 30, 19~.2