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Home My WebLink About3790-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....~,..~1.~0 .......... Date ............... ~lgUSt..2g.~ ................. , 19...61B. THIS CERTIFIES that the building located at .-~g/~I~..AV~I'iM~ .................................... Street Map No ....................... Block No ....................... Lot No ..... ~tt;Lt, l~..~T.~...~ .................... conform~s substantially to the Application for Building I~ermit heretofore filed in this office dated ................ ~eb~.aa.:~y...2g, ................. ~...., 19....68 pursuant to which Building Permit No..~.~..~.0..~ dated ....... ~J&.~tJ~..~ ............................ , 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 ........ ..... ~r.~.V&t~ ,.g~a~e....(~ ~$o~.¥..~l~J~l~g.) ....................................................................... The certificate is issued to .......... ]~&v-~,~,,(~[~..,~%.~e~.)...... ............................. ~. ........................ towner, lessee or tenant) of the aforesaid building. FO]t~M NO. 2 TOWN OF $OUTHOLD BUILDING DEP~RTMENT TOWN ~LERK'$ OFFICE $OIJTHOLD, N. ¥.' BUILDING PERMIT CrHIS pERMIT MUST BE KEPT ON THE, PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3790 · Z Permissior; is hereby granted to: ~vf,.~ ~ er .... ,... .................. ~e~a~.~.~a ..................................... ..................... I~:i,.%u,e.~ ..................................... t~;~3~t~t~r~e~;~te~.cm..~.4~a~`~t~eee~~:L~ at premises located at, ...JJ/,~.,,.~e~.~..~lF~ .................................................................................... ' pursuan~ to application dated ..................... '. .......... ~.'~J).~.....~ ........ , 19..~[., and approved by the Building Inspector. Fee $.....,,~i~.~ .......... lrOBM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ............................. Approved ........................................ , 19 ........ Permit No ..... Disapproved a/c ....-~; ............................................. ' (Building Inspector)L. APPLICATION FOR BUILDING PERMIT Date ..... ~..~...?. ................................. , 19..~....~... 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 property must 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 sh~ll be occupied or used Jn whole or in part for any purpose whatever until a Certificate of Occupancy shell have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pumuant 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, housing code, and regulations. ............. / (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...... ~~....~...~ ....................................................................................... If opphcant is a corporate, s~gnature of duly authorized officer (Name and title of corporate officer) 1. Location of land on which proposed work will be done. M,.:~4o.'~..~~ ~.._C~e~('.~. Street and Number /~)?~-~,t. ~ o'~, ~ ~ ~...~'~'/~:~ '~~Z~...~ ...... /~' ........ ?'",~ "61'~ '~:' .............. Municipality .......... 7' ............... 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: Existing use and occupancy ...~~ ................................................................. ' .......................... b. Intended use and occupancy ..v._~ ............................................................................................... 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration ............. ' Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............ ..~.....¢~..~.x..~..'~,,. ............................. 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 c~rs ..................... ~ ,~.~.,,~...~. ...................... 6. If business, commercial or mixed occd'pancy, specify nature and extent of each fy/Se of use ............................ 7. Dimensions of existing structures, if any: Front .....~'..~...~.' ............. Rear ..... ./.?....z. ................... Depth .,~,~ .~.(. ........ Height ...~.... .............. Number of Stories ............?. .................................................................................................... Dimensions of same structure with alterations or additions: Front ..... ~..~... ..................... Rear ......... ~ ................ Depth .....Z..~...~.' .............. Height .....~.r.. ........... Number of Stories ...........~.. ................. 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height ..~.~ ...........Number of Stories ......... ./. ........................................................................................................... 9. Size of lot: Front ..... ~.~....c~.....¢. ......... Rear ...... ,~¢~.;..t~,. ................... Depth ..... ~...~..0....z. .............. 10. Date of Purchase .......... ~.~...~..~. ................................. Name of Former Owner .~/.~x~-~...Z~2.~z~¢~..~ ............. 11. Zone or use district in which premises ore situated ..................................................................................................... 12. Does proposed construction violate any~,~ ~/_~,~.~-~_~ /,///,/z°nJng law, ordinance or regulation? .......... '/~i ........................................... 13. N a me o f Ow ne r o f p remises~f~.. · L¢4..~.¢¢~.......Add tess 7¢~/-~¢4z,f4/,'f-~ .... ,~'. ~.../~'L ..... P h one N o~ ~.~.~....~..~..~'..~ // / Name of Architect ..... ............. Address .....~;,~.~ ........... Phone No ..................... Name of Contractor .~..~..Z..~..~ PLOT ......... DIAGRAMAddress ..../.Z/.....¢~....%~.~.'.~<.. ............. Phone Na~....~..';.~..~..~7 Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock dimensions from property lines. Give street and block number or description according to deed, and show streetz names and indicate whether interior or corner lot. ~ STATE OF NEW~;~ORI~,^ ~" /SS r'~ ./%/'2-') /o ~ ~ COUNTY OF .... f~'~)'*:~:~'~'[~"~ '' ,)t ~/{~ L~ ~, ..... &~.~...~~ ........................................... ~being dulygorn, deposes and soys that h~ tho applicant (Name of i~ividual signing application) -- 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 before me this .......... ~.~... day of .....~..~..~.G.~ ..............., 19.~? ~ ,~ ~ ,~ ~ / ................. ............................. " ' ...... '~' ~r, ra~V ~ub~ic Stat ' ~'~' ~" ' ~ {~ ¢;ommissioe Expires March 30, ~,9 ~