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Home My WebLink About3011-zFOR~ NO. 4~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. ~ 2790 Date A~gU~ 8 1967 THiS CERTiFiES thor the bui[dir~g located at ....... .}][.~.~.¢.~...T~¢~ ....................... Street Map No. Y~ Block No. J~Z Lot No~..q~ P~ ~.~e ..................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............. ~.~..~ .......................... , 19.~.. pursuant to which Building Permit No..~.~:.~..~. dated I,{Z~D 7 , 19..~.~., 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 ........ ............. ~.~.~.. ~.. ~r~.. ~.~.~..~:~.[ ~.~ .................... The certificate is issued to ......... .~.~..?~...~.~.~ .......................................................... (owner, lessee or tena,nt) of the aforesaid building. Buildi~ '~16ector FOI/~ NO, ~ TOWN OF $OUTHOLD BUILDING DEPARTMI~NT TOWN CLER]('S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3011 z Date .......................... ~,~h.....~. .............. , 19...~.~. Permission is hereby granted to: at premises located at ...... ]~'/~'-"~a~b'o~-'~.:~qe ................ : ..................... : .......................................... ........................................................ :~s~ho~tte'": ....... :'"7 ................................................................ pursuant to application dat~d .; ............................. ~....[.:..~ ........ 19..~., and approved by the Building Inspector , Fee $'"~'~00;: ......... ~ ~/ r~ ~ ~. Bu,ldinbrihsPe'~:tlr FOR~ NO, 1 'I~WN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ............................. (Building Inspector) / APPLICATION FOR BUILDING PERMIT Application No ............................. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises ar public streets or areas, and giving o detailed description of layout of property must be drawn on the diagram which is part of this application. c. The work dovered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regu at OhS for the construction of buildings, additions or al.t~erations or for removal or demolition, as herein described. The applicant agrees to comp y w th all applicable laws, ordinances, bui ding code and regulations. ......... Bar. br.a.. S .t.e,r. lir~ .................................................. (Signature of appJicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... !~.$..°..~!.t?~.~?]....~'~.~....'.S.'.l?.~.l..~.~q'.6 ................................................................................................ 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 ...... ~-J.~?~.z?].oj.o..,~...L..~.~,g ...................................................... .g.¥!~.~.~.p.G~..e,. ......................................... Municipality 2.State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .......... ~;J?'..e..]::'?:.J:?);~...I.~.9.}f[c~ ..................................................................................... J i 3. NatUre of work (check which applicable): New Building .................. Addition ........ ~ ........ AlteraHon Repd~ir Removal DemoliHan .................. Other Work (Describe) . . , 4. Estinated Cost .............. :~M.~.~,0..0...O. ............................. Fee . 5°00 (to be paid on fi ing this app ication) ............. : .............. Number of dwelling units on each floor ............... i ............ 5. If d~'elling, number of dwelling units If ge rage, number of cars. . nozzle ' 6. If b~siness, commercial or mixed occupancy, specify nature and extent of each type of use ............... [ ............. 7. Dim nsions of existing structures, if any: Front .......~...~2.~ .......... Rear ....................... ~.-~.,..' ........ Height .....~.fL..~.~.. ..... Number of Stories ........... .6.~.~S~.~ .......................................................................... [ ............ ~: ft Dim nsions of same structure with alterations or additions: Front ..... ~.~...~.~i., ................. Rear ......2. ....... .* ......... Dep ....~.~...~.~ .............. Height ....~k..~.~.¢ ........... Number of Stories ...... ~.$~G~.9. ............ I 8. Dim ~sions of entire new construction: Front ~ ~ Rear...~...~.~.e ........... Depth qA Pt ............. 4..~¢ ~ ~ ~.~..~ ..... Name of Former Owner ¢ ' ¢": ............. ] I. Zon ~ or use district in which premises are situated ......... ~&~..~ ......................................................................... 12. Doe~ proposed construction violate any zoning~aw, ordinance or regulation? ............. .~ ........................... ~ ............. Nan,e of Architect ~o~e --- Phone No. PLOT DIAGRAM L,ocot~ clearly and distinctly oil buildings, whether existing or proposed, and indicate ¢ll set-back dimensi¢ns from property Ii les. Give street and'block number or description according to deed, and show ~treet names andllndicate whetherl iht ~rior or corner lot. ~ ~. ~, %~ ~L ~ k~ ~ ~ NEW YORK, ~ S S ~........~:~.~..... ........... ; ................. being duly sworn, deposes and says that he is the ~pplicant (Contractor, agent, corporate officer, etc.)j of said o~ner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this applic]tion; that all statements contained in this application are true to the best of his knowledge and b¢l et; and that the w~,rk will be performed in the manner set forth in the application filed therewith. ; Sworn to flare me this STATE OF COUNTY