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Home My WebLink About4109-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...... i~r~,~.d..~f~,~e~t ................. Street Map No ..... X~ ............. Block No...Z~, .............. Lot No ......~ ......... ~.~1~'...[~.1~'~.~1; ..................... conforms substantially to the Application for Building Permit heretofore filed in this office doted ............................. C~;~J~.......~.l ........... , 19..(~8. pursuant to which Building Permit No....L]-.l_O.~..~, dated ........................... 0e.t~ ....... .~$ .......... , 19...~,8, 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 ........ .......... ~z ~.v~.t,a .. cm,~ .. £~,J_1.~/...~.~ze_.~,~ ...................................................................................... The certificate is issued to ........~,~Ts.]:e~t...~m.:[i~te~: ............ g~e-~ .................................................. (owner, lessee or tenant) of the aforesaid building. FOILM NO. ~ TO~'N 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? 4109 Z Permission is hereby gront~cl to: . J'lml~l,...lil. tJiJ' ............................................. ....................... ~t~tel~ .............................. to .J~l~&.~..~..m~..&~..ezl~*,~.. ~®t ~,~e ........................................................ at premises located at .........:~.....I)~l~J..g't, .............................................................................. ........................................... J'e.'. · ~,ll,f..£e.i,k. ......... ll,,.Z,, ....................................................................... pursuant to application dated ................................ O~t~ ....... .~ ......... , 19.~1~.., and approved by the Building Inspector. Otgc ~,e ~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT D te ............................ ...... , INSTRUCTIONS a. This appJication must be completely 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 p~emises, relationship to adjoining premises or public streets or areas, and giving a detailed de~ription 'of layout of property must be drawn on the diagram which is part of this application. c. The work covered by th~s application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building ~nspector 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 Deportment 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 er 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, housing 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. Name of owner of premises ..~..l~.~3,~,g~..l~.&;~lRg~. ................................................................................................................ 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. ,~Aap No.: ........................................ Lot No.: ........ ~ ......... Street ,~,,,4 Id, .~1~..~.~.~ Orchard St ]lev Suffolk ' , ............................................................................... un,cipa,ity 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ........ D~ve3.]_ti3~..&..~t.~e ............................................................................... b. Intended use and occupancy ........... ~..&~.~.e.~.~..~.~..~..~g.~..~.~...~.~-.~.~..~.~.~.~g..~.~.~;...&.g..e. ........................................ 3. Nature of work (check which applicable): New' Building ~ ................ Addition ...~....'~.. ......... Alteration ...~ ........ Repair .................. Removal .................. Demolition .......... :.....:. Othqr Work (Describe) ........................................ 4. Estimated Cost ...... /i.0....O...~.......-~.. ............. .................. Fee '(to be paid on filing this application) 5. If dwelling, number of dwelling units ...... .o...~..e.. .............. 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, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories .......................................................................................... ~ ............ i ......... Dimensions of same structure with alterations or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..~.'[,-6 ......................... Rear ..... ,...1..1,,6 ......... Depth ...... 6 ............... Height .................... Number of Stories ..Olle. .................... : ....................................................................................... 9. Size of lot: Front ........... ~7.~. ............ Rear ......... .77- ..................... Depth .......... .1.~O+. ............ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zon~ or use district in which premises are situated ....~..~...d..~,.l~..~..~....~..A'.~....d...~..8..~.. ................................................... 12. Does prOPosed:construction violate any zoning law, ordinance or regulation? ......... ~.O .............................................. 13. Name of Owner of premises ~.e...T~&l~ll, el3r. ................. Address .....~'.QW...~..U,~.(~],][ ............ Phone No ..................... Name of Architect ........................................ i ............. Address ............................................ Phone No ..................... Name of Contractor .......... ~e ................................ Address ............................................ Phone No ..................... whether interior or corner lot. 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 77~ STATE OF N~]O~ i ';- ~ ~' 1~' · couNw ........... ............................. ~.~..~ ................................. being dui? sworn, d~oses a~ Says t~tl he is the applicanl (Name of individual signi~otion) 77 above named He s the ~ ~ ~) ' (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sa d work~ ~ file this application; that all statements contained in this application are t~e to the best of h s knowled~ and ~elief; and that the work will be performed in the manner set fo~h in the abplicat~n filed therewith. Swam to before me this U ~ L ~ ~ / 3.~ day of ...... 0e¢obe~ ........................ N~ARY PUBLIC, StYe No, 52-0618100 S~lk C0un~ ~mmission ~r~ M*rc~