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Home My WebLink About4086-zTOWN OF SOUTHOLD BUILDING DEPARTMEN~T Town Clerk's Office Southold, N. Y. Certificate Of Occupa: ncy No. 2, .DS.,0 .... Date ...... .... Jul.~. ..... ll, .... , 19..6.9 THIS CERTIFIES that the building located at · ..~I~,%n .Road .............. Street Map No ............. Block No ........... Lot No. gOt~l:ha%~l,, l~eu. ~.a~k .......... conforms substantially to the Application for Building Per:mit heretofore filed in this office dated .... .Oc':,:¢)h~.:~;.. ~4,..., 19 .~ 9. pursuant to which Building Permit No. ~ ,4086..K dated ..... Oc-{xYX,¢~r.. J.~, .... , 19.6~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... a~(.'~ ,~2~':.,~o.%.:y' 3x~.~;L]~9 ............... ~ -- .......... The certificate is issued to ... ;c~a~ ic~.~'~ .,~e~jion ~ · Jo~. ~,. · Fin~ · O~ ....... (oWner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval '/~luil~hng Inspector FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Yo BUILDING PER~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4086 Z Date ........................................................ , Permission is hereby granted to: ~a~n St ~t1~ ~ ~ece~o~ ~uil~?~..~:..~.~..~ .......................................... ~ ~a~n ~ ~r~ .................................... at premises J~ated at . ~ ...... 8eut~l~ ~,~, ...... [ ........................................................... pursuan$ fo application dated ............... · ....... ........ Building Inspector. Fee $ ........................ ' ' Building Inspector J FOEH~NO. 1 TOWN OF SOUTHOILD IIUILDIING D£PARTMIiN~ TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Approved " t9~ ...... Permit No. ~'~ ~ ~ ~ Z./o/& Application No .................. ; .......... D sopproved a/o ......... ............ ................................. ........................... APPLICATION FOR BUILDING rERMII ........ .'...¢.. ......... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in !nk and ~ubmitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relatiionship to ad oining premises or public 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 corr~menced 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 througkout the progr,',ess of the work. e. No building shall be occupied or used in whole or in Fart 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 f~suonce 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 ol, terations.,~o.r~,l:~r, ~:err¢~.~. or _de. rnoLiti~, as b,erein described. The applicant agrees to comply with all applicable laws, ominances, ~Ucb~[~gas~V~U~d~lations. ' AMERICAN L~GION -- : ~OU~HOLD, N~ ~. 11971 (Signotdre of applicant, or name, if a corporat on) Store whether ~pplic~nt is owner, lessee, egen~, erchitect, en¢ineer, generel contrector, electrician, plumber or builder. ....................................... ..................................................................................................... Name of owner 0f premises ................................................................................................................................... If~plico~ is o c~o(ote, signot~e~f duly authorized offi~e~. ...... ~ I nrn;,~; and title of,~p~(¢ officer, /~ 1. Location of land on which proposed work will be done. Map No: ........................................ Lot No.: Street ~n8 Number .......................................................... ~ .................................................. ;; .......... Munici~lity 2. State existing use end occupancy o¢ premises ~nd intended use ~n¢ occupancy o~ proposed construction: e, Existing use end occupency ................................................................................................................................... b. Intended use and occupancy ...................................................................................................... ~"'Noture of work (check which applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ......... ...'~..l.~..O...t.l~...O, ............................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars 0/¢ ~ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use 7, Dimensions of existing structures, if (~ny: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8, Dimensions of entire new construction; Front ............ L.~..~, ............... Rear ........... /...~c....~ ........ Depth ..... o~,0..~. ......... Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ ! 1. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ......... /~ .~.~ ........................................... · GRISWOLD. TERRY- GLOVER~ [ ~.Od ..................................Phone No.Z~.-..2~t.7.~, 13. Name of Owner of premises .............. A~i.E. Rlt~N..[i~.i.O.N~ s~ ..... Name of Architect ........................ ~.OllIHOLD~.~..~:...t~j~ress ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NeW Y([~q~"K~.~ ~ ~ t S S cou T OF ...... ........ ?'~....~.....~(L~.~..~..]'/~....~.'' ......................................... being duly sworn, deposes and says that he is the applicam (Name of individual si~f,~ --applicati°n) ~' ~ -- oba,e ............ ....... , ....... ................................... . ~ -- (~~ corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this applicotioq are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn tobefore me this ~...~ ............. day of ......... ~...; .......... ,1 ,.~..~.~.:...,~. Notary Pub, ic ~~;~~ ............ Co y/ .......... ' ......... NOTARY I~UBLIC, Sta~e at ~ew York No, 52-2564175 Suffolk 0aunty