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Home My WebLink About3096-zFORM 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWH CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE DF OOOUPANOY Z 2600 October 28 ., No ............. Date ............................... THIS_ CERTIFIES that the building located at . ~.Op~..B.e..~.~.h., .O.~;~.~.e. ....... Street capt. Kidd Map No. · .I~..~.~..~.~.e.s.. Block No ...... ~:... Lot No ..... 17 ...... l~l~tt~;.~UOk,. conforms substantially go the Applicati,on for Building Permit heretofore filed in this office dated '...~. ~.~ ........... 1~.. pursuant to which Building Permit No..~Q~. ~t~ .: ..... ~.?~ .......... , ~9...6, ~ i~ue~, ana ~o.eo~m~ to ments ~of the .applicable provisions of the law. Tho .occupancy for which this certificate is addition to one famil~ dwellin~ issued is ........................................................................ ..... The certilicate is issued lo . T. (owner, l~ssee or tenant) of the ~or~said building. ,Suffolk County Department of Health Appr,oval ......................................... Building Inspect TOWN OF $OUTNOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDIING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3096 Z Date ... ~ 20 , Permission is hereby granted to: Th~ ~. · .~i.~ho~'. · .A/C · · ...~., .~.~.. e~n$ ~l.~ .............. ................. · ~fa.t~i.~l~ek ......................................... to .~.~ ~..ad~i.~iom.on~,~ exi~l~ d~e.~.~i~ .......................................................... at premises located at ..~.....1.~.,...;.~..~id~..[S.%~ ........................................................... .............................. :.....~.mmd...B~eh..D~£~.e ............... ~at%i~xck ................................................ pursuant /~0 appli~atibn doted .... ................ ; .~y, ~ ~0. .......... 19~..., and approved by the Building Inspector Fee $...~.00. .......... . l~uIIomg inspector" i ( FOI~i~ NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om ned ...... ....... , Approved ........................................ , 19~ ..... Permit No ............................. Disapproved a/c .................. ~,~r.....,.....-~-'-'-~..~:.~../ ........................................ .......................... ,m?;~ .......................... . ...................... ~...'-T .......................... ............... (B~il~iing Inspecto~i ............................. 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 mL~St 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 o 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolitlon, as herein described. The applicant agrees to comply with all applicable laws, ordinances, buil~ng code .and regulatio_,j~s. ~ (di~;~u'/~'f oppli~o;~, or name, if o corporation) ......... ........................ (Address of al~plicant)/ State whether applicant is owner, lessee, agent, architect, engi,neer, general contractor, electrician, plumber or builder. ................ ................................................................................................................................. Name of owner of pLemise, ~ ~t.V~ ~. ~m~. ................. 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. Mop No.: Lot No.: ........ · ......... / Street and Number .................... ......... .............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ..... ~.~. J.~J.A..~...~........ · J .~. ~..'~,~ · J..L). J~. ~...~. · ~,, ........................................ b. Intended use and occupancy ............................. ~.'.~.~,~ ................................................... : ................................ 12. , Nat Jre of work (check which applicable): New Building .................. Addition .................. Alteration .............. Rep ~ir .............. ~i~ Removal ................... Demolition .................. Other Work (Describe) .................................... Esti noted Cost .......~. ................................................... e .................................................................................... (to be paid on filing this application) If d?elling, number of dwelling units ............................ Number of dwelling units on each floor ....................... If g.~roge, number of cars ........................................................................................................................................ If Business commercial or mixed occupancy, spec fy r2oture and extent of eaGh type of use ................ r ..... ? , Hei iht ........................ Number of Stories ...................................................... v ........................................ ~ ........... Dirt ensions of sa~e structure with alterations or additions: Front ....... ..'~.....~. ................... DaF th ................................ Height ............................ Number of Stories ................. Din ensions of entire new construction: Front .................................... Rear ........... ~ ........ Depth .................. Sizg of lot: Front ............................ Rear .................................... ~ t' ~'""'~uep n ................................ Dat~ of Purchase ........................................................ Name of Former Owner Zor~e or use district in which premises are situated ..................................................... ~ ................................... Doe~ proposed construction violate.anv zonina, law, ordinance or reaulation? ............ :.':.Z ..................................... INar~e OT uwner or premises ........................................................................... ........~- ....................... Nar~e of Architect .............................. .~....~.....~ ...... Address ...................................... Phone No .............. Locat property I whetherin PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr nes. Give street and block number or description according to deed, and shaw street names and indic. :erior or corner lot. ~ / STATE OFI NEW YORK, 1. e c COUNTY DF ................................ J'~"~' ~ ~~'~*~j~-~/~ ....................... being duly sworn, deposes and soys that he is the opplio (Name of individual signing application)J .J_ ' above non'ed. He is the ....................... ...CC... ............................................................................. I (Contractor, agent, corporate officer, etc.) of said owper or owners, and is duly authorized to perform or have performed the said work and to make ,and this applidption; that all statements contained in this application are true to the best of his knowledge and belief; that the w(~rk will be performed in the manner set forth in the applicotiojA filecJ, A,herewith. Sworn t? b~fore me this ' ......... ...... ....................... ' 9J..'. Nota~ PulpilY,\ .t./.;~,...,..~h.,...(...(,.....~./~...,¢~..,,,...t'?2; ..... County .................... (Signat;r;,~¢i;;;;~")' ..... ; ........ ~' ~ [} MARION k. REGEhl L~ [jI fl0fARY PUBUC. State (d ,'. ' ,~ J~o. 52-3233120 Suiloik I " ;[erin ~xpires ~arch 30, 19~