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Home My WebLink About3104-zFO~M NO. 4 TOWN OF SOUTHOI. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~]/~..]~oa~...~/.S...E~t;e,t;e.~t .................... Street ...................... Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................................... ~,~t' ....... '1~......, 19..~.~. pursuant to which Building Permit No. ~..O~k~. .... dated ............................... }.~.....2~ ........ , 19,,,J~.~, was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ..... P. ~.t.v~ Ce ·. ~ne...~m.i.~..y...d~e .1.~ ~ ........ (eas.t .. Gue. s~...~t~u~e ~ ......................................... The certificate is issued to ...~I~V?I ~L..~.~ke~. .............. ~.~. ............................ (owner, lessee or tenant) of the aforesaid building. Building lnspecto;-'"'l ............ FORM NO. 2 TOWN OF SOOTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN"FIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 310 z Permission is hereby granted to: pursuant to application dated ............................. .~I/:.....L[.....~,~. ....... 19~,.; ~d ci~proyed byt ~ · '~ Building Inspector , Building Inspector ~ FOK~,~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om,ned ....... App(oved ........................................ , 19 ........ Permit No ...... ~.J...O.....,~.....~- L: ................. .................. ' ......... ..... i ......... Application No ....... J. ...... APPLIGATION 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 propertymust 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 th? progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until (3 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 Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Oe~'r,a I Con~r~tor Nome of owner of premises ....... ~li.v.J,d,.,~.,.,,JJ.eltke.I .......................................................................................................... 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: I ~ Lot No: ~ O/'~ j j Street and Number .......................... .~.J.~Jlf~.~,...[.~.J.~t~ ............................................ ; ............................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy .................... Dw~ .J.,J. jll]g.. .... i ......... : ..................... : ............................. .~ ......................... ...... b. intended dse and occupancy ...... J~JJJ J JJ J~ ............ ~ J ~ ........................................................................................ 3. NatUre of work (check which applicable): New Building .................. Addition .................. Alteration ..J( ........... Rep( ir .................... Removal .................... Demolition .................... Other Work (Describe) ................................... 4, Estir ~ated Cost ........... .~..0..,.~..~..~.., ................................ Fee ' (to be paid on filing this application) 5. If d,¢elling, number of dwelling units ........ J ................... Number of dwelling units on each floor ......................... If g6rage, number of cars ........................................................................................................................................ 6. If b~smess, commercial or mixed occupancy, specify nature and extent of each type of use ............................. 7. Dim+nsions of existing structures, if any: Front ........ .~0..~ ........... Re(~r ....... ~J}..~ ............ Depth .....~0.~. .............. Height ........... .J.6.~ .......... Number of Stories ........J ................................................................................. / '~"' · .......... ~;; :" Dimensions of some structure with alterations or additions: Front ,,,.,~..,~,. ...................... Rear ...... ~. ........ .......... 6' Dept~h ......... 40.f .............. Height ......... ! ................... Number of Stories J ...... ' , Ele~ik porch 8. Dimensions of entire new construction: Front ............................Rear ..bU.j.~j, ll~..~.jt~iJ~ ............... .......... Hm~jht ....J.4.r, .................. Number of Stones ...... J ..................... . 9. Size]of lot: Front .....~,~1~. ............. Rear ...~4,~0 ............... Depth .J~-~$.i~l ..................... 10. Dat~ of Purchase ........................................................ Name of Former Owner ........................................... ......... 11. Zo~p or use district in which premises ?e situated ............... t~ .......................................................................... 12. Doe{ proposed construction violate any 'zoning law, ordinance or regulation? ........... ~.~. ................................. 13. Na~e of Owner of premises J).eY. jJ.d...~.~.,.~l.e/l~.J....¥Address ..~..J..l~e~..~t...[~.J.~.~,.~.~.¥ f~hone No.~,J~.J~ff~'.~,~. Na~e of Architect ...................................................... Address ............................................ Phone No ................. Na~e of Contractor Lr.,...I.,...U.~.i.l.i.t~.,..g.e,,...,I.W.~Address .EJ.~r~#m. ll...l.~l. IH~,.~,¥ ~none No.~.JJl.~.~'.3.~. i PLOT DIAGRAM I L.ocat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions fn property li~es. Give street and block numbers or description according to deed, and show street names and indio whether interior or corner lot. STATE OFI NEW~:¥OI~I~, ,,~( '/, ~ couNw ;OF ......... S.S. ~ ~~- [ ' ~ be na duly sworn, deposes and says that he is the appliC (~ame of i~vi~, si~n~ applicaTon) above na~ed. He is ..... ~ .......................................................................................................... .......... ~ (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 lie this opplqaton; that all statements contained in this application are true to the best of his knowledge and be f; and that the work will be performed in the manner set forth in the appliqation filed therewith. Sworn to be~ore me this, .............. ,: .......... .................................................................................... Notary Public, "'~"~~c"St~Z~P~V~~o. ~-~me~0 (Signature of applicant)