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Home My WebLink About3677-zTOWN OF SOUTHOLD BUILDING DEPARTMENT~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...'~...3~'7 ........... Date ............ .....~Cj~t~..21~r ............... , 19..~?~8. THIS CERTIFIES that the building located at 8~it~..J~'~.e. ...........................................Street Map No....]..~I~9 .......... Brock No ....................... Lot No.....G~'~]L:~Z~,,...I~e~..~....1.o~.J,&2. conform~s substantially to the Application for Building Permit heretofore filed in this office dated ........................... ~.tO~...,~..?.~ ............. , 19.6.~... pursuant to Which Building Permit No..~J.~.~...~...~. d~ted ................. Oc~t:o3oe~...~t.],, ........... , 19..6~/.., was issued, ahd conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ............... ~.~v~e. · ~ne...~'e~m~...~e;~tng ..................... .......................................................... The certificate is issued to ............ .~1~t,1;~..,~t1~I~.~I; ............ ~. .......................................................... (ownqr, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 3677 Z Date Oeto~e~ ~ 19....~.~... Permission is hereby granted to: .................. ~.~ur...:~ter~e~t ......... ; ........ : ......... ............... ~z-...~.~ .............. ~l..~....ts~ .................. ........................... Zee. t.so~.~t~ ................ to .~.~..~.~.. ~...e.¢~ ~:to~...~. :~_~..~z~t~.. a~;t~t~ ...................................................... at premises located ar .............................................................. i .......................................................... ........................................ :~..h..e.F..e...~;~.,/.~ .......... ~),v~enpo.~,.,i .......................................................... pursuan¢ to application dated ............................. .O.~..t¢. ....... ~.....i ...... , 19.~.~...., and approved by the Building Inspector. Fee $. ~.s,.~.O. ............. Building Inspector[ * '~pprovea ........................................ , 19 ........ FOI~M NO. ! TOWN O~ SOUTNOLD BUILDING DEPARTMEN~ SOUTHOLD, N. Y. Permit No. 3 77 Application No. )~/ ~' 7 Disapproved~'~'~'~'~' ~.--~-~'"~ ~ ~ ~ .... ................................. J'"'"""'""'"'"'""(Buildlng Inspectf) APPLICATION FOP. BUILDING I~ERMIT Date INSTRUCTIONS a. This application must be completely filled in by typewriter or in i,nk 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 bn the diagram which is part of this application. c. The work covered by th,s apphcat~on may not be commenced beforD issuance of Budding Permit. d. Upon approval of this application, the Building Inspector will issueia Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progr2ss of the work. e. No building shall be occupied or used in whole or in part for any p~rpose 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 Building Zone Ordinance of the Town of Southold, Suffolk County, New Y~0rk, 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 laws, ordinances, buildling code and regulations. (Signotu?e of applicant, Dr name, if a corporation) ........... ........................ ............. '0 ........... : ............. (Address of applicant) State whether applicant ~s owner, lessee, agent, architect, engineer, genera! contractor, electrician, plumber or builder. Name of owner of premises ~..?~'~ ~..~ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No.: .Z].,~.~..] .~......, ................. Lot No.: . ./......~.~..~ ....... Street and Number ..~....~.;L..~4'...¢Z./.../.~ ............................. ' ........ QT.r~..~?~..<~..-/., .~...~../¢~../., ............................... MunicKpality 2.State existing use and occupancy of premises and intended use an~ occupancy of proposed construction: a. Existing use and occupancy ..... .~..~...~./.~ ..~.....~'....¢~...~.~..~..~ '' b. ntended use and occupancy ../..~..~...,dt;~..~.~.....~...'~.f.:'~...~.~.~'/...'~'...~.':i~. . . / 3. Nature of work (check which applicable): New Building .................. Addition ....~ ..... Alteration .................. Repair ................ ~.,,,~moval .................. Demolition ........ .~,.... Other Work (Describe) ........................................ 4. Estimated Cost ,...~../~'?~...~..*,..f~...~.. ............................ Fee .....~..i..~..~. ......................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....~..-'~....~.'i ............. 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 .......~,,,~.~ ........... 1~gar ..... ~..~..O,<~..../. ................ Depth ...~../. ....... Height f~-" Number of Stories Dimensions of same structure with alterations or additions: Front ~" Rear '~.,,~.. / Depth .......~..~'....~ ............... Height ...... ~ ................. Number of Stories ..../... ......................... 8. Dimensions of entire new construction: Front .................................... Rear ............................ Depth ........................ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..... ~.~.~...~. ........... Rear ....../...~...~...Z ................... Depth ...-~...~.~ .~...~ ................. 10. Date of Purchase ~...~./ff.~.~..~......../....'~..~..~.?.. ................. Nome of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ...... ...~...,~...d'.~.~,..q~...~...~..~... ............................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....,r~'C....~. ................................................. 13. Name of Owner of premises ~.~',~. ,~,¢?.,~..~...'~..C.~.,.~....Address'-~..~..,.~'~..~.ff../.:~.~.'~-.~/.~'.~:f. Phone No. ~.../.~..:~.'~..~..'~'~ Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... STATE OF NEW'~YOR. K~ }' S S COUNTY OF ~ ......... ~' ' ' ..... ~x~ ................ ~~.~.~ ................ being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ...... .~..~..,'f~'....~..,'~-~.. ............................................................................................................................ (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 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/~' ~,~,/j~ .......... ...,. ......... of .... ____ ......................... , ounty ...................... .............................. Notary Public, . ................ No, 41-1780550 Qtmeiia Coun~ /