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Home My WebLink About4442-zFORM NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT Town Clerk's Office Southold, N. ¥. Certificate Of Occupancy THIS CERTIFIES that the building located at .~.,.0..,#.,. ;..l~.... 919~.&.~...&W~treet conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ A~ig.. 30., 19&9 .. pursuant to which Building Permit No.. dated ........... ~ag ..... 30., 19.69., 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 .... I~$Wat& .~. tra~Ll~, d~all~lag .................................... The certificate is issued to . !iO~i .B~'kle .&. Ig~fe ......... 0~fl~l~m ............... (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ..... .II.,.R.,. .......................... FOR~ NO. ~ TOWN OF SOUTHOLD 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) Permission is hereby granted to: ....... l~.,,,~l,..~m~...~...#.tt.~ ........................ ..................... .~.e..~.. ....................................... pursuant to opplicatlon dated ....................... ~ ......... ,~. .............. , 19...~. and a~Proved by the Building Inspector. ........ II'qJM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMEHT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E ~ ~19 ........ xamined ......... ~ .................. , Approved ........................................ , 19 ........ Permit No.............................~J ~ C'1 ~- ~- Disapproved a/c .............. ~= ...~.......~........~......~.., ~ ....................... :.... APPLICATION FOR BUILDING PERMI~ ' :. ...... 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 issucmce 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 pursuant to the ~Build!ng Zone. Or.clinance of the Town of Southold, Suffolk County, New, York, and other applicable Laws, Ordnances or r~egumtions, tar the construction of buildings, additions or alterations, ,e'r for removal or demolition, as here n descr bed The applicant agrees to comply with all applicable laws, ordinances,/~uilding code, hou~t'n~c-c~e, crnd regulations. _ (Signature of applicont~er~name, if~a~corpomtion) [ - (Address of applicanf) State whet~h~r applicant is owner, lessee, agent, architect, engineer, general contractor, electrcan, plumber or builder. ............. ......... ........................................ : ...... ............................................. Nome of owner of premis~....Z:./...~;..,.;~?/.,'.~.~.~......';..~...../...~:.t...~..J.'~...~-~ .......... .~; ...... !'. ....... ~ ....... : ..................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on wh~.h-I~:~oc~ed work will.~m-de~e. Map~No.: ........................................Lo~ No.: .~.. ..................... Street and Number ...... L~.~..!..~...~..?.~. ............ .~..k.......O....~......~........~.,.....~......~..~i ..................... '.. Municipality 2. State existing use and occupancy of premises and inteJ~Lded use and 'ocCupancy of =rOOosed ~onstnmtlnn. a. Existing use and occupancy ............... ~ ........................................................................................................... b. Intended use and occupancy ...... ; ........ .~..~..~.V..~.~... .................. ' ....... ,.; .......................................... ; ........... 3. Nature of work (check which applicable): New Building ....... ~ .......... Addition .................. ^Iteration .....~/..... ...... Repair .................. Re~rnoval Demolition ............... ;.. Other Work (Describe) o .................................................. 4. Estimated Cost .................................................... ; ....... Fee .......................................................................................... (to be paid on filing this application) 5. I~ dwelling, number of. dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars .................................... ' .................................................................................................... 6. if business, commercial or mixed occupancy, specie! nature and extent o~ ,each type of use .............. 'r ............ 7. Dimensions of existing structures, if any: Front .......... ~:' ............... Rear ........ P.. ..................... Depth ....~ ............ Height ........................ Number of Stories ............................................................................................. Dimensions of same structure with alterations or additions: Front '/ ~ / / ~ ' Depth ................................ Height ........................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ..... ...,,4~ ..~ .................... Rear ............................ Depth ........................ Height .................... Number of Stories ..................................................................................................................... 9. Size of lot: Front ........... . .~......~.....~. Rear .............. ..~......~.. ........... Depth ...... ..~.....~...../...(...4/......~.~' ,, ~ / 10. Date of Purchase ......... ./....~..../..~.....~. .......................... Name of Former Owner ~.~...~..~...E.~..c...~..~...~.~..~.....v.---'/ ........ 11. Zone or use district in which premises are situated ........................................................... 7 ...................................... 12. Does proposed construction violqtp any zoning Iow, ordinance ~r._regulation? ............. /~...~. ...................................... 13. Name of Owner of premises...~..,~.~/.~:..~.....~...~..r..~.(~..AddreSS .?.(~...~..?.~...~...~.~...~ ........... Phone No.~)....~....~...,,3.'2...?.-~' Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... 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. 17' COUNTY C,= .......... m"' ............ being duly sworn, d~o~$ ond ~:~y~ thor h~ is th~ ppplicam ........... 'ng 'aa 'on) , . above named. He is the ...................................... .~..,,:,~....~ ......................... t ................................................................. · '~' (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 tFae to the best Of his knowledge and belief; and that the work will be performed in the manner set forth in the applicqtigh filed therev/fth. ., Swam to before me this '~ / / .... ........ ............... z'-~. ,,..~,,/') '~ ',// ..=":-/-:::..~.; ............. z':;.-~'-.~,d~"~..~.. ................... ~.. ..................... Notary Publi~ .6.~Z,4'./,-2A~.(~~,.~ ~,~f.~ (Signature of applicant) ~ / /~TARY PUBLIC, Sta~ of New ¥or~ Ho. 52-8~25850, ~UHoIk County Term Expires March 30,