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Home My WebLink About3808-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at I~/S. · .~ee~,on. DF. ........... Street Map No..:~:X;~ .... Block No3{3{3g ......... Lot NOX3~.. ~O~lt;ho3~. ~,I,~ ........... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... t~a3~ch..~6. , 19.68. pursuant to which Building Permit No.380~ .. dated ........... ~4~011 .... ~., 19~8.., 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 The certificate is issued to . .l~(~.itb_ Cohe~ ....................... (A~r~e3~ ............ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval .~[.~* ............................. Building Inspee~r FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING pERMIT (THIS PERMIT MUST BE KEPT ON THE P~EMISES UNTIL FULL ' COMPLETION OF THE WORK AUTHORIZED) Permission is hereby granted to: .......................................... ~.~.~ ~. ~ ~.~,. .............. pursuan~ to epplic~ation doted .............................. ~. .........~.~ ........ , 19...~...., and approved by the Building Inspector. FOR,.~ NO, ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ~ 19 ........ Permit No. Disapproved a~.....:~.':~ ................. APPLICATION FOR BUILDING PERMIT Date xjx/~ ~ ~Z~ 19 6~ 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 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 Building Permit pureuant 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 lows, ordinances, buildina code,t¥ _ ~____,, ~.._housing codeqand 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. If applicant is a corporate, signature of duly ad~horized officer, (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: ............................ : ........... Lot No.: ........................ Street ond Number : Municipality 2. Store existing use and occupancy of premises and intended use and occuponcy of proposed construction: a. Existing use and occupancy ........................... ~ .................................................................................................... b. Intended use and occupancy ............ ~(:..~ e..~ ........................................................................ 3. Nature of work (check which applicable): New E~uilding .................. Addition ~ Alteration ~'~ Repair .................. ,, Removal .................. Demolition .................. Other Work (Describe) ..~...e..W....~.~.T.C.'.~5.~..I.?..~i~"~*,~ 4. Estimated Cost ....... .~.. .......... : ...................................... Fee ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ..... .~...Y...~. .............. 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 ..... 3.~..] ............. Rear ....~...~.'..'.~.. .................. Depth Z..~...'..~.. ........ Height :~ ~ Number of Stories o ~'~=- Dimensions of same structure with a,lterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... '.~....~..'.~. ..................... Rear ...~..~..~.~.. .............. Depth ...~..?..!.:.~. .......... Height .)...3.1 ............. Number of Stories C31u~ ............................................................................ 9, Size of lot: Front ............................ Rear ~'°~ Depth ...... ..~..o'l ~ 10. Date of Purchase ................................................................ of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............. :.....~......' .......................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............................................................ ]3. Name of Owner of premises ...~..R.i~T.~........~..9..~..~.~.. ...... Address ~-~' ~o~. ............. .t ............................. Phone No ..................... Name of Architect ............ ?..?..~...~.. .............................. Address .......... ~Y'B'6~'"'~'~ ...........Phone No ..................... Name of Contractor ..~...qff.~/~.e...C...f..~.cr.~.~.q,.~.....Address .....~...?..,~..?,~..u..x.~k.~ ............. Phone No, I.:..:...l., ......... 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. STAT[: OF NEW Y~RK, COUNTY OF ...~.J' .... , (Nomegf i~/divldual signing opp~cation) above named. He is the ........................ ~~,e.~,. ............................................................................... ; .......... (Contractor, , ' , 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 thegpplication filed therewith. Sworn to before me this -- .......... Notary Pu bi '~:./~.~......~... ,...../. ~..~c..,~_ ~. _~'...~ Cou at; ............ ~' PP' ~AI~iON/ A,/~.G E N I ~erm TITLE NO S 20<.)054 J OCT. 26, 1967 SURVEY FOR EDITH F, COHEN SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. ~iUARANT£EO TO, SCALE' 1% 40' NORTH' FORK EIANK ~ TRUST CO INT, ER-¢OUNTY TITLE GUARANTY LAN~ SU~V~ YOR NOTE, LOT NOS REFER TO AN UNFILED MAP ENTITLED WEST $OUTHOLD ON THE SOUND.