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Home My WebLink About4087-zFORt~[ NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. Y. Certificate Of Occupancy THIS CERTIFIES that the building located at .W/8 .¢®~&~'. Ay® .......... Street Map No~oo~ .l~&.y .l~l]ock No ........... Lot No. ~)?... 8&~l~old. · .~I.]G, - · · conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... dated .......... 0V~...1 ~ ..... , 1968., 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 ..... .P.~..~.~.a.~..~..o.n.~...~..a~...1~..d.¥.~.~.~..~.~ ................................... The certificate is issued to .. D~l~.le -l~&lk' O~ow~ner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ......... ](,ll, ...................... ..... ......... Building Inspector louse t 1~ FORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.o ~087 Z Permission is hereby granted to: ................. ~..~ .............. £~.~.~ .......... · ~ ......................... ~.~.~.~.../~ ....... ~!.~.'." to ............... .~J..~ ~ ~) ...~....0. ............................. t re ises locate' t Z..~.., 7 ~ ~ ~ b/~ ~ ~ ap m ao .......................................................................................................................... pursuar~ to application doted ........................... /....~--- ........ ...~.-~..-~......, 19.~..~.., and approved by the Building Inspector. Fee $ ...... : ................. Building Inspector TOWN OFSOUTHOLD /_~,,t~ ,TOWN CLERK'S OFFICE .. ,. ExomJned ................. /"'~"~'~.~..~..., 19-....~..~/ Appli~tion No. ~. ~ ..................... z.~~9..~,~, .o...~.~.~...~ ~ ~ /~.; ~ ..... Disapproved a/c ........... ~ ............................................................................... ~. ~, ~ · ~.. ~ ~' APPLICATION FOR BUILDING PERMrI' ~ Date ........... ; ................................................. 19 ............ INSTRUCTIONS a. This applicotio~ must be completeJy filled in by typewriter or in ink and submitted in duplicate to the Building~,~ Inspector. b. Plot plan showin~ 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 must be drawn on the diagrant whicJ:l Js part of this 6ppl'ication. ~:~ 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 th~ apPi cant. Such permit shall be kept on the premises avai ab · 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 Bui d ng 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 demo t on, as herein descr bed. The applicant agrees to comply with all applicable laws, ordinang~ b.uilding code,~J~ou~i.ng cod_.,.~e, and regulations. ............. · ~__~re ~c~a.~,zn a m :, if a corporatio~i' ........ (Address of applicant) State whethe~_,~,7~ ~,~applicant~s////,"",--..gwner' les.~see,~~ier~, arc ',tect, engineer, general contractor, electrician, plumber or builder· Name of owner of premises ,~ ~-~"~i .................... '(~Z~f'"Z' ' i~; ............... i ................................. i ................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed wo~rk will bjll d~, Map No.: ............... :.~ ................... ,. LclLNo..G~,~./)~..~.."~ ~re~ and~ o r ~unici~li~ State exisHng ~se ond ~c~poncy of premises ond ~qn~e~ use ~nd ~u~ncy of propos~ con~tmction: ~u~ ..................... '"~'~' ~ Z; ~' ~': ; a. ~ing use and ~ ~ ...[ ~; ~ . ..7 .................................... ; ........... ~,...,..~ ....... b. Intended use and ~cu~ncy ....... :~ ............. ......... ~ ....................................... :...;: .............................................. ~ ..... 3. Nature of work (check which applicable): New Building .................. Addition.../... Alteration .................. Repair .................. Removal .................. Demolition .................. Other Wo~ (Describe) ........................................ 4. Estimated Cost .................... Z..~.....~.....~I......-~... ............... Fee ............... .~...~ ......................................................... (to be paid on filing this application) $. If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ........... ./. ............... If garage, number of cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, f any 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: Fron(... ............. ~ ........... Rear ......... ~ ......... Depth .......°~......0.. ........ Height ....... /...~.. ..... Number of Stories ................. ~ 9. Size of lot: Frdnt ...... /......~....~... ......... Rear ........... .~'....~..~iiiiii'"'"1~:~';~ ........ ~"'~""~ ................................................ : 10. Date of Purchase ........ ..~...~../,.L.~ ........ ../~....~.~.. ............. Name of Former Owner ................... ~....~.../....V...L..~..S......?.. 11. Zone or use district in which premises are situated .................... '.~..[.~. ......... ...~....~...~.../....~....~.~....~..~...~.. ................... 12. Does proposed construction violate any zoning law, ordinance or regu at on? ~ ........ ..... /DA ^/ ........................... 13. ~ame or uwner or prem ses ' ~ ' ~ Address ~-~ -- '~" ~ ..... Phon " .................................... ~ ....... ~/~'~ ~¢ .X~ ./v. ~. · .~ ~*t ~ d¢e mo ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bo~k 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. -a I I STATE OF NEW YORK, / c c COUNTY OF, ................................ ~/_.~--/-./7_, ~/'/~:'IS-7' ~--I~1...~...~1~'..~.. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .......................................... 4~.~..~.~.~..~ ............................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to ~ke and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set fo~h in the application filed therewith. Sworn to before me this ~ day ....... ............ ............. ~"'"~"~?':""~'""~'u~'"r'"..~ ...... Cq~ cu~¢~u/J ..... ($ionoture of Ppplic~nt)