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Home My WebLink About4497-zFORM NO. ~ TOWN OF SOUTHOLD BUHDING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupnncy No. ~.1+.~.27 ...... Date ............0c~ .....12 ..... ,19. ?.1. THIS CERTIFIES that the building located at .. 1~/~. 0~,ie~t~t .~ve ...... Street Map No. F. l,gst · · · Block No...t9 ...... Lot No. 3. F.$she~ .lst.an~ ..... N,~, .... conforms subst~tially to the Application for B~d~g Permit heretofore f~ed in tMs office dat~ .......... 0~ .... ~.., 19. ~9 p~su~t to which B~l~g Pe~it No.. ~9~' dat~ ...........~t .... 8"', 19' '6~ was issue, ~d confo~ to ~ of the req~ ments of ~e applicable pro~sions of the law. The occupancy for which this ce~ificate is issu~ ~ $.~lva.to. one. family, d~et LSng ....................................... The certificate is issu~ to · ~arry' '0 ~ · ~lb~t'&' Wife" ~er~ ................ (o~er, less~ or ten~t) of ~e ~ores~d b~g. S~olk Co~ty Deponent of He~ Approv~ ...Rend~g ......................... ..... //'~/'/''' ~'~fi~' I''-'''~'mp~r ........... TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. N°. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) , ~l~l§T Z D~e .................... .e~t~ ......... ~ ............... , ~..69. Permission is hereby granted to: at premises located at ...................... ~dI~I~.,.~..~D~.4)C~....~9....~,~,t~Ej4~4t. II; ..................................... ................................ ..~......~.e...,..~.s..~.~.,.z...,.~.~...~ .......... ~..,,~. ................................................... pursuan¢ to application dated ...................... ~ ........ ~ .................. , ]9...~1~ and approved by the BuildiDg Inspector. _Fee $..~JJJ...~l.~ .......... FORM NO. 1 . TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ......... ~....,.~......., i9..~.? SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No .......... ...................... Application No. /''~/''~ /9' ? Disapproved a/c .......................................................... ~ .... APPLICATION FOR BUILDING PERMIT ................................... ,, ..... INSTRUCTIONS o. This application must be completqly filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing Ioca¢ion of lot and of buildings on premises, relotionship to odioining premises or public streets or areas, and giving o detoiled description of layout of property must be drawn on the diagram which is par~ of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon opproval of this application, the Building Inspector will issue a Building Permit to the opplicont. Such permit sholl be kept on the premises availoble for inspection throughout the progress of the work. e. No building sholl be occupied or used in whole or in pa rt for any purpose whatever until o Certificote of Occupancy 'shall have been granted by the Building Inspector. B~uilding Permit pursuant the APPLICATION IS HEREBY MADE to~'the- Building Deportment for the issu~c~ce of to Building Zone Ordinance of the Town of Southold, Suffolk County, New Yor~,,~nc~th~ ~j~licoJ~ Lows, Ordinances or Regulations, for the construction of buildings, additions or alterations, or~/?e~'~9~al~, ;¥j~o~on, as herein described. The applicant agrees to comply with all applicable laws, ordinanc ~es 0n.~~ / . .......... ......... ....... ./..... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor; electrician, plumber or builder. ........................................................................................................................... Name of owner of premises ..Z~..~...~...,~.~......~.~...~..~. ....... .~..: ....... .~....~'../..Z..~...?'.../~.....~.... .......................................... If applicant is a corporate, signature of duly ~thorized officer. (Name and title of corporate officer) ~1 // ~/~ 1. L~tion of land on which proposed work will be done.Dl~ .......--/~ .......... · ..................... ~.. Lot No: ..~....:.......~ Street and Number ..... ~...~..,.....~.g~ ....... .~.~....~..~.~N ...... ~.~ Municipali~ 2. State existing use and ~cupancy of premises and intended use and ~cupancy of pr~ased c~struction: a. ~isting use and ~cupancy ............ ~~ ............................................................ ~'.. ................................. b. Intended u. and ~copancy ......... l ~ ...... ~. "D ............................................................. 3. Nature of work (check which applicable): New Building........~ ....... ... Addition. ................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Est Jmated Cost ....~.,/..'...(~....0.. ,.. ~ ........................... Fee ........~...~4.....'~.. ............................................................. (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 natureand extent of each type of use ..... ~ ...................... 7. Dimensions of existing structures, if any: Front ....... ..'~...i..; .......... Rear ....... ~ ............. Depth .........~. .................... Height ~ Number of Stories -- Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ......... ~ ............. Height ........ .~.; .................... Number of Stories ....... --:..-. ............................. 8. HDie?ge~tsion~.~.f..e~.t.ir.~..newc~Smt~eC~oO~:s~[r~ts.....~..~. ~'~ Rear ........ .~....~'...~....?.. Depth ~ ~ ..~....7~.. 9. Size of lot: Front ........ ..~......~......~.?.... Rear ....~.J...~.......~.?...... Depth..,~.....~...~........~...~... ........ /' 10. Date of Purchase ../~'~.~....~...~.. ................................... Name of Former Owner .~...~.~. 11. Zone or use district in which premises are situated ~'~'~' 12. Does proposed construction violate a.~y zon. ing aw ord nanc~e_~ reaulati~. ~,~.~..~._.~ 13. Name of Owner of pre_m ses ~ , ~..~...~..~'..~...~..-~... Address .~'.~J~)~'~, '~. Ph~,~ I~1~ ~- Name of Contractor .~,.~.~.~.~.~z.~.~ ........ Addr~s ~.~.~......~/~ Phone No PLOT DIAG~ Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~ lines. Give street and bl~E numbers or description according to deed, and show street names and indicate whether interior or comer lot. STATE OF NEW.~YO~(. ) S¢ cOUnTY OF .°. ...... t ....... .., '"" ';'.'";:;'~"!~)';":': ...... ; ........ ~ ................ g Y p y t he is the app cant t~a:me ot indiVidUal signing application) above named, He is the .................. ~ ........................................... (C~tractor, agent, co.orate off cer, etc ) ........ of said owner or owners, and is duly authorized to perform or have perf~ed~he sa d work.nd to make and file this ~pJication; that all stotements contained in this application are t~ t~e ~st~hi~knowledge and be el; and that the Work will be performed in the manner set fo~h in the ap~i~t~fiJe~t~it~ Sworn to befpre me this ~ ~ [gc~$.A~ ~/~, ~///I ~ ....... .~..~.. day of ..~~ · . No B~-00~88 ~ ~ , · ~e~ ~ O, ~ ........... · ........................................................ ............ , ....