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Home My WebLink About4050-zPOlg~ ~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I'OWN CLERK'S OFFICE SOUTHOLD, N. Y. CI~I~TIFIOATFr OF' OCCUPANCY No.. ~-. 3345.. Date ......... ~.~.C.~tql~;~]~...],7, ...... 19~. THIS CEI~TIFIES that the building located at .ll:l~l. lane .................. Street Map No. I~],e~. .... Block No ............. Lot No3'] ... ~eCOl~:l~,. l~ew..York ......... Park ~ 1097 conforms substantially to the Applieati.on for Building Permit heretof, o~e filed in this office dated ....... ,selate~b~r... 12, 19~8. pursuant to which Building Permit No.. &0$Q .Z dated ....... IS.~p~Mtthe3[ .... 1[[,19.6e~, was issued, and conforms to all of the require- ments .of the applicable provisi.ons of the law. The .occupancy for which this certificate is issued is . l:~iV&t~. ~lle. £~limll.y. (~el.~.lLIlg. ~:[~ .~. &. S~e- ~h~. The ce~ificate is issued ~o .... ~1~. ~,. ~t ..................................... (owner, lessee or tenant) of the ~or~aid building. .Suffolk County Department of Health Approval ......................................... .? T/f / f ............ Building Inspector FOftM 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? 050 Z Permission is hereby granted to: ......... t~oT~..~...~e.t~ ..................................... ........ · ,~,z....:l.2,~ ................................................. .............. l~,eumt~ ....... lt~-Y'~ ................................. to .... ~B~).~.~.a~l~t Lc~.~..aa..ear~Let ~nS..cJ~e:~ ................................................... at premises located at ,..~..~. ....... ~,~L~&~f....J~il3'.k- .......................... .............................................. ........................... I~..l~m ......... .l~eem~e ........ .X,,.X~ .................................................................. pursuan* to application dated ......................... ~p~ .........~ ........... , 19.~.., and apprOVed by the Building Inspector. Fee $.....~.00 .......... Building 1 nspect~? NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No ................................ Disapproved a/c .....~. Application No. L/tO ~ O APPLICATION FOR BUILDING PERMIT Dote .......................... , 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 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the censtruction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances, bujIdi~g code and reguJ~?s. , o ......... ~.~.~ ...... ~..._~.~: ........................... (Signature of app~t, or na~e, if a corporation) ....... ...................................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, ~eneral contractor, el~trician, plumber or builder. Name of owner of premises .~~'~~ .................. ' ................................................................. ' If applicant is a corporate, signature of ~ author~ed officer. (Nome and title of corporate officer) 1. Locat on of arLd on which proposed work w~ be done Ma~_ No ?..~../......'¢'~.........Z.~.-~'Lot No' ' " "" ............. ~treet ond Numo~-~..;.:..~-.~..~,.....:..~.....:.,..-~. .............. -. ...... ~..:.~ ........................................................................ ~ 1 Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occu~anc· ~) ~, y ../ ......................................... ~ ........................................................................... b. Intended use and occupancy'.-.~....~c~.....~~-- ~ ' .............................................. 3. Nature of work (check which applicable): New Building .................. Addition ........ ,~......... Alteration .................. Repair .................... Rerg~val .................... Demolition ................... ,~Other Work (Describe) ...................................... 4. Estimated Cost ........... ~-~'[[..~..,~. ..................................... 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 ........................................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each t),pe of use .................. .~ ............ 7. Dimensions of ex)sting structures, if any: Front ~' ~) Rear ~ r.P Depth ~' ~; Height ...... ./....~.. ............... Number of Stories /~"~" ...... ~ R ~'o D~mens~ons of same structure w~th alterahons or addmons: Front ............ x~ ................ ear ................................ Depth ....,~..~ ................... Height ......... ../...~.. .............. Number of Stories ............~. ............... 8. Dimensions of er)tire new construction: Front ~ o / ............................ Rear :~ o ' Depth ~ ~' /' Height / r~' / ............................ Number of Stories ......... ~ ....... 9. Size of lot: Front ...... /..~...::. ............ Rear ...... (..~....~. ............. Depth / / ~ 10.11.ZoneDate afar PuUsreCh;i~r~ic~' '~ ................................................ ~i~r~es are situated..N..a?..~F.~r.~~; ................. ~' ............................. .......... 12. Does proposed construction violate.,~,j "~any zor~ng,//_ law,,/,~ ordinance ~_~_'~'~'°r regulation?,,,~u~::7~,~:t~...~:~.,L~~ .. 13. Name of Owner of premises .............. ~...Address ............................................ Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No .................... PLOT DIAGRAM Locote cleorly and distinctly oll buildings, whether existing or proposed, ond indicote oll set-bock dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate ~'ior or corner lot. - _~ / _ ~.~ whether ~---~._~.. '~ ~ ._~...~.~i. ............ being duly sworn, deposes and soys that he is the applicant above named. He is the ......................................................................................................................................................... (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 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 forth in the application filed therewith. ~-~. Sworn to (:~fore me this /2 / ~ ; ........... .................... /" , Count ~ gnoture ot opp can~ Notary Public, . .............. ;~U&A~I..£~k~E.~IeA.~EER ........ ~ Itotary Public, State of N~w York Ckualified itl dP~W York Coun~:y ,