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Home My WebLink About3731-zF~P~iVf NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ..... ~,...32.0.1. ......... Date ................. AUgUS:~..2.7., .............. , 19.6B.. THIS CERTIFIES that the building located at ...~.e, rlt~Z.e.~'..j~l. ..................................... Street Map No....~e~.r.~ ...... Block No ....................... Lot No...].9...Sauf~hol~..~...~'o,~k ................. ~ ~'Sate~ conforms substanttally to the Application for Building Permit heretofore filed in this office dated ..................... Ho,4'~itl]ae~...2.g, ................ , 19..6.7.. pursuant to which Building Permit No...~..7.~.~....Z. dated .......... No.v. er~:~..,~O.~ ............... , 19...6.7.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ...... l=~v.a~e..one..~a~;t.Y..~e~l,~,,tn~ ........................................................................................ The certificate is issued to ......Mat.~r, he~..J...~i~,terak...(c~ner) ................................................... (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, BUILDING PERMIT O"HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETI,ON OF THE WORK ~,UTHORIZED) N? 3731 Z Permission is hereby gronted to: ..... ;..,!.~.~ ....... ~,~.y-,sm,,c-~ a~,. ~l..v~. ........................ .............. · ~:~ '~'~ ~','~l ............................................ to ~&l~..lm .m~.d ~ ~.~ ..~..~g.. ~i2lzz~ ....................................................... at premises Io~ated at ....~D.,~.,...~.O.. ........... ~.~rR~...~[~Z'J5 ................................................. pursua~q$ to application dated ....................... ~(t-Ve~et~--..~ ....... , 10..~., and approved by the Building Inspector. ,Fee $ ~. ~ .g.~ .............. uuilding inspector (z TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ 19 ........ Application No ............................. Disapproved a/c ..~.....::~-- APPLICATION FOR BUILDING PERMIT ,Date ..... ./..~.~....~?,. ..................................... ,I 9....~.'...Z 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 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 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 York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or dem~[tion, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing ~'~l~, .and regulations. / .... .................. (Signature of apj~icant, or name, if a corporation) State whether applicant ~lessee, agent, architect, (Address of applicant),., engineer, general contractor, electricifn, plumber or builder. Name of owner of premises ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) lq' Street and Number ......... ~,.~.~..~,/.~./~,...,~.I~,Z'~,~, ............................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....~ ,~ ~......_.._...~~......'~..~ ..................................................................... b. Intended use and occupancy ...~.........~ ................................................................... 3. Nature of work (check which applicable): New Building .................. Addition ~ Alteration Removal .................. Demolition .................. Other Work (Describe) ........................................ Repair .............. :~ /~ 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 cars ............................................................................................................................................. 6. If business, commercial or mixed occupancy, specify__ ,.o_nature and extent of~,__ ,~,egch.type of use .......... ~_ ,~,~../...v.....~z- 7. Dimensions of existing structures, if any: Front .....~..~. ...... Rear ........ ~....~P..~.......: ..... Depth ...o~...~.~ . Height ........................ Number of Stories .................. v~_ ,~ ........................................................ ;;? ...................... ...... x D~mens~ons of same structure w~th a.tterat~ons or addmons: Front .................................... Rear, ............................ Depth ................................ Height/.'~ ........... Number of S~tories .../.~..~ ..... .~1 8. Dimensions of entire new construction:--Front "~":"~''°''j''~''' .. _~a ~, Rear ...-..,.;,~.,..Q.....~...---~.-c_, ~-~,,, Depth "~' '~7~ Height .................... Number of Stories ...................................................................................................................... 9. Size of lot: Front ..... ~...o~... .............. Rear .../.~ ........................ Depth ...... ../...~...~.T .......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district Jn which premises are situated ..................................................................................................... 12. Does proposed construction violate arty zonirt~law, ordinance or regutation~ / 13. Name of Owner of premise~?K/~.z.~.~'~ddressl.~.../.....~-e~~. Phone No ..................... Name of Architect -{/' ' ' Address Phone No PLOT DIAGRAM I.ocate 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. Ir° STATE OFNEW YORK, COUNTY OF ............................. ................................................................................................. being duly sworn, deposes and soys th.at he is the applicant (Name of individual signing application) above named. He is the ......................................................................................................................................................... (Contractor, agent, corporate officer, ~tc.) of said owner ar 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 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 befor, ce me this ~ ~ .......... ~...~.. day of ..~.~ ......... ,'~..~. ~<-)//am~,,) c'7 5-,0~,o,, . ,, .. ................. Notary Public' '~'~"~'""~'7~'"'"~'~ntY0~l ~. ~,¢cr~qI (S.g~;~a~g' of apphcant)' Term Expires Nl,~rcn ~,