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Home My WebLink About4427-zFORM NO, & TOWN OF SOUTHOLD BU~.DING DEPARTMENT Town Clerk's Office $outhold, N. Y. Certificate Of Occupancy No.~!+173 ...... Date ...........Mal~h... 16 .... , 19 .~1. THIS CERTIFIES that the building located at .l~y- A. ve ................... Street Map No.. ~ ........ Block No... ~ ..... Lot No..~ .... ~t~t~a~.. ~..~. ....... eo~orms subst~tially to the Application for B~ld~g Permit heretofore filed in this office dat~ .......... A~...igi..., 19.69 p~su~t to which B~d~g Pe~t No..~. dated ........... &~ · ' "1'9" 1969., was issued, ~d conforms to ~1 of the req~e ments of ~e applicable pro,ions of ~e law. The occup~cy for w~eh this ce~ifica~ is issu~ ~ . ~vate 'g~ge' · '('Ae~esse~' ~ldg') ................................. ~e certificate is ~su~ to .EAw~A. ~ke .... ~er ............................... (owner, less~ or ten,t) of the Mores~d buil~g. Suffo~ Co~ty Dep~ment of He~ Approv~ ...... M.E, ......................... d~g Inspector FOI~I NO. ~ TOWN OF $OUTHOLD 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? Z Permission is hereby granted to: .................. ~...~.~;.~...~L~. ~ ... ................................. ............... ?,~l;.t;~,.~, .......................................... to ................ I~L~,..X~..~.~L ~,-~ ................................................................................ at premises located at ........................ ~.~.....~l~,~r..~ ....................................................................... ......................................................................... I~ ~ t,:Lt~l~....l~ ,Z* ................................................... pursuan¢ to opplicotion doted ............................. ~ ...... ~'~9 ........... , 19.~9.., ond opproved by the Buildin§ Inspector. // .~ . ,.? / ..~ l,^ ',,,wN G, ,,.UT.O,.O ~ ~ ~ TOWN CLERK'S OFFICE ~ ~ ,ow.o~, .. y. Examined ...... ~~......./..~..., 19..~..~. ^,,roved ........................................ , ~9 ........ Pe,,it No....~..?..Z. Disapproved a/c .............................................................................................. APPLICATION FOR BUILDING PERMIT .... ~ l /~ ......... ....... .t.....,, ...... INSTRUCTIONS o. 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, relationsh p to adjo n ng premises or public streets or ~'~ areas, and giving a detailed description of layout of property must be drawn on the diagram which is port 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 ir-~l;ection 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 Bui ding 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 remava or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinance,~ b~lding code, housing c~,~e, and regulations. (Signature of applicant, or name, if a corporation) (~[Iress at appficant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, p umber or builder .~..~cL~ ' Ha me of owner of premises ..F....~-r~...~(~/....../.~....'.?-~.~ ............ ~ ........ ~....~.....~....~......~.. ........................................................ ~ If applicant is a corporate, signature of duly authorized officer ~' (Name and title of corporate officer) ;ocot,on of land on whch p~ ~ w be dens ~ap No .Y:... ~ ~'- "~ 1. ' ' sea w~ ' · . -: ...... : ...................... ~ ....... Lm No.: ~..~ .......... Stm~ and Number .... ~...~.~ ~ ~.~ . ~ ~ ~ ~/~ .......... ~... ~. .......... ~ ............................................. ~/ - ~0 ~ MuniciNli~ 2. State existing use and ~cu~ of pm~ and in~n~ use and. ~cu~ncy of pr~ con~mcti~: o..,..ng ~. and ~c.~ ...... ~.~ ~. ....... ~.~Z~ .c ..... ............ ............................................................ ~ Y .............. ;.;-~ ......................................................................... ; ..................... 3. Nature of work (check which applicable): New Building .... ~Addition .................. Alteration .................. Repair .................. Removal .................. 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 cors ............. ~ ...................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent,, ~,-°f each type of use ............................ ,, / 7. Dimensions of e~xjstingstructures, if any: Front ...... .~Z/.~..... .......... Rear .....~..~.. ................. Depth .~,.~... Height ..../.....~.....~Number of Stories ........................................ ~ ~ ................................................. Z .................. Dimensions 6f same structure with olterotions or additions: Front ....................................Rear ............................ Depth ................................ Height ............................ Number of Stories ................................ 8. Dimensions of entire new construction: Front ............. ..~.~ ...........Rear ........ ...e~...~ ..... Depth ..... ..~..~ ........ Height .................... Number of Stories .................... ~ .............................................................................. 9. Size of lot: Front ................ ~... Rear .................................. Depth ............................... · 10. Date of Purchase ....~'.~..~.~--'~-----'-' ................................. Norn~of, Fo/~rne~r ~wner ~.~.C~....~../.~././..~./~./.~.-~..' -- ........... ! 1. Zone or use district in which premises are situated ............ ~.....~ ........ ;;;....~/~.,~ ................................................. 12. Does proposed construction violate any zor~g law, ordinance or regulotion?/~..~:.~.U..;~ ............................................ 13. Name of Owner of premises ...~.~....~.:...~.~.~ress .....,/..~..~...~.~....~..~.~'~-~ Phone No~..~..~ .~.../..~./ Address ~ Phone o Name of Architect .................................................................................................. N ..................... Name of Contractor ................'~...'~ ...................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether exkting 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 i~terior or corner lot. ?/~_~_ ~ /~ ~.~ t (Name of individual signing ol~lication) above named. He is the ............................................... ~ ....................................................................................... (Contractor, agent, co,orate officer, ~c.) of said ~ner ~ ~nem, and is duly authorized to perform or have perfo~ed the said work a~ to ~e ~d file this application; ~t all statements contoined in this applic~ion am tree to the best of his knowl~ge and belief; and that the work wil~ ~ff~med in the manor ~t fo~h in the ~lic~i~ fil~ ther~ith. Swom to ~fom ~hJs ~ _, ,~ ~ ~ //~ ~ // ..... ~t~ kbli 1..~ k~- (SignOre of applicant) ...... , ', ~e~m~pires M~ch 30, ~