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Home My WebLink About3810-zFOI~M NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~....~..~..~.~. ............ Date ............ .A~gl.~'l:...2.?.~. ................... , 19.68.. THIS CERTIFIES that the building located at ...J~It~..~I~JQ.i~.~.V.~D,U~ ....................... Street Map No ....................... Block No ....................... Lot No...(~I~I~'*O~..~..:~O~'~ ...................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................... ~.f~h..~.~., ......................... 19..~J.. pursuant to which Building Permit No. dated ..... ..,J/~, ..~...~.....~.~...~ ................ , 1 9...J~l~., was issued, and conforms to oil of the requirements of the applicable provisions of the law. the occupancy for which this certificate is issued is ........ ............................................................................... The certificate is issued ¢o ..... WJI~.~...~J~!I3~i~IIJ~G .............................................................................. (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF SOUTHOLD BUILDING DEFARTMENT 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? 3810 Z Permission is hereby granted to: PUrsuant to application dated ............................... ~:,..~.~....,...~, ig.~..; an~l opp~roved by the Buildifig Inspector. Fee $ ......... ~*..:~ ....... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................ ~ ............... , 19..:~ .... Permit No. ;..~,~..~..*.~.~L.~ Disapproved a/c ...... ................................... : ........................... (Building Inspector) APPLICATION FOR BUILDING PERMIT Date ~ar{3h ~. 19...6..8 INSTRUCTIONS o. This application must be compieteJy 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 shell 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 construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. .... .~. ~/..M~.....c~b~4C~... ,~.. ~a..~ ............................. (Signature of applicant, or nome, 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 ..... ~..~..e.~....~..~...3;'~,'..s.~[..o. ............................................................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate Officer) 1. Location of land on which ~roposed work will be done. Map No.: .......... ~ ......................... Lot No.: ....~ ............... Street and Number ~ ~9~O~ ~e '. g~,~t~O~e Munici~lity 2. State existing use and occupancy of premises and i~tended use and occupancy of proposed construction: a. Existing use and occupancy ........ ,~.~.~...~.~ ........................................................................................... s~.me with'~ addition b. Intended use and occupancy ........................... 3. Nature of work (check which applicable): New Buildinb .................. Addition ..,,~,~ ........ Altera*ioh .................. Repair .................. Removal .................. Demolition.i ................ Other Work (Describe) ........................................ 4. Estimated Cost "~"'~"'1' ......................................... Fee ...... ~.~.0...0. ........................................................................... · ' I~'"'"' ,~ (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 type of use ....~1.~'1111 .............. 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ · " new construction: Front -:4'8, ............................ Rear ....1.8~ ................... Depth ...~..,. ............ 8. D~mens~ons of entire Height .................... Number of Storiesolle..~...~, .......................................... ~.~. ............................... .~.......J. ............ 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ....... ~&!!...d.'ls.~ .......................................................................... 12. Dbes I~r0posed construction violate any zoning law, ordinance or regulation? ...................... 1~ ................................. 13. Name of Owner of premisesl~...~e~.e,~]~ ................ Address ...... glt.t,¢~..~lO~tl~ .............. Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ....,~1~1~ ...................................... Address ............................................ Phone No ..................... 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. STATE OF NEW YORK, [SS COUNTY OF ..{~.~],,1~ ............. 3' ' ' ............................ ~.[l...~.%..~...~.....~.~.?..e..~.~9. .................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) He is the ................... 0W~..~*...b?,t;Lqb~ .................................................................................................. above named. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to m.ake and file this application; that all statements contained in this application ore 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 ................ ................. .............. , 2'o'-' , , ..... ....................... Notary Public, /J.,7/~.M~¥..q....C{'..:.../../i,~ld~....../County (Signature of applicant) (-- //'/f/ MARION A. REGENt , !uI'IOTARY PUBLIC, /State of New York ~o. 52.3233120 Suffolk Coun[~/ 'form ~,xpire?' March 30, 19~.¢~