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Home My WebLink About3740-zFOI~M ~0. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No....J~..3~.(~9 .......... Date ............ ~gl~l~...~,.~., .................... , 19.~:~... THIS CERTIFIES that the building located at ..~/~LJ~J~lJ~..,I~,o~,Cl,..CO~II~...OJ[ ........... Street Ackerly Pond Lane Map No ....................... Block No ....................... Lot No.80~t. hO~,.:,N,.¥ ...................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................... ~ell~l~T..t~v .............. , 19.6~/.. pursuant to which Building Permit No. dated .............. J~C~II]C~:;C'...1LS,. .......... , 19...6~'., was issued, and conforms to all of the requirements of the applicable provisions of the Jaw. The occupancy for which this certificate is issued is ........ ...pz ~v.a,te.. ~ne., fam~l.y... ~T~ell/ng ........................................................................................... The certificate is issued to ..... M~,.,.&.~l~a,~...Hen~.y.J~,~h~Jt...Jol~ll~r.) ..................................... (owner, lessee or tenont) of the aforesaid building. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. - · BUILDING pERMiT . ('FHIS PERMIT MUST B.E KEPT ON THE PREMISES UNTIL FULL COMPLETION OF ~THE WORK AUTHORIZED) . Permission is hereby granted to: ' ' --~r : ' ' -...L...;,i~~. .......... ,: ....... : ....... : ............ :..~.., ¸to et premises located at ~.~`~.~..~`.~...~.~..~.~.!~.~:~.~;~;:.~.~.~~.~:~.~.~`.~.~:~ ............................................. ................................... ~:i~ts...l~.,~. ............................................... - .................................... ; ...... pursuant to application dated ..................... .~.~.?...~ .......... ~...t ............. , 19~.?..., end approved by the Buildihg Inspector, , Building Inspector FO~.M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE Examined ~'~ /~"~ , 19 Application No. Approved ........................................ , 19 ...... Permit No., ...... Disapproved a/c ...~,,, ........... ~.~,~7......~~.:..:~.~,~¢~..::.~,~,~ ............... ~~~, '~'~'~"i~;~i;;i ................................. APPLICATION FOR BUILDING PERMIT Date ..............,:,~. ¢/:...('.: ...... ).~..'i. ..................... , 19~.,.~. ...... 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 propertymust 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 o 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 pa rt 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 demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) ............................... ~'~';~';;"~T ~' ~'~ ,' ~; ~) ............................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Oo N~.B.~...~...~.~<. .......................................................................................................................................................... Name of owner of premises .............................. ............. ....... ~l ......... .... ....................................................... If applicant is a corporate, signature of duly authorized officer. / / /.~ ~ ~ ~ (Name and title of corporate officer) - l. Locetion of land on which proposed work will be done. Map No: .: .......................................... Lot No: .................... ........ ......................... .... ~unicip~l~ty ~ 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: ~ ~:~.c:~ a. Existin~ use ~nd occupancy ~ ~ ~ ~ b. Intended use and occupqncy ~'~ 3. Nature of work (check which appllcable): New Building .................. Addition ..,.;2~. ......... Alteration :......J..: Repair .................... Removal .................... Demolition .................... Other Work (Describe) 4. Estimated Cost . .~ '.x~t. CZO., ....................................... Fee ...~, .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwd[ing umits ............ l ................ Number of dwe[[ir~g units on each floor ...... ~. ..................... If garage, number oF cars ......... ~.....Q,...'.4.~ .... .~ ,~ ..... ..~..~...~.~.~.~..i~. ......................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existing structures, if any: Front ~,~Z., Rear ~ ~''~ Depth ..~.~,, .................... I Height ....... ..~..(.;;..J[.~: ....... Number of Stories I ~,,,~ .............................................................................................. Dimensions of same structure with alterations or additions: Front ....... ~..~....I ............... Rear ..... ~.,."'~.,.'. Depth ~.~.~.. '~.~... Height ....... ;~.~....'.~..~..'. .......... Number of Stories ....I.~.~-~. ........................... 8. Dimensions of entire new construction: Front ....... ~: ..... Rear ........ ~.~/:'.~..' ....... Depth ....~:?.:.~..~..~.! .......... Height ............................ Number of Stories ............................ 9. Size of lot: Front .......... ~.~..¢.;'.:!.T.: ..... Rear ........ l).:./...'!.?. ........ Depth ......... ~..~..,R..(./..; ......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ I 1. Zone or use district in which premises are situated ................................................................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ......iM.~ ........................................... 13. Nome of Owner of premises .~¥!?....}i:.!~.~E~.~.G~:.~J .......... Address ..~'~T~.I(~.LJ,-~ ........ .~...[. ..... Phone No ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Nome of Contractor .~..~..¥..~.~.,~.~¥.~.L~...i.~.1..~.: ......... Address .~..~..~I'.JD..t,I~. /?/..~ , Phone No. ~.~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate a set-back dimension~ from, property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW~(ORJ(~ COUNTY OF .~lf~..-..~... ...... [~'~' · ~.I,,~'L~ ~, .~.Q~K.~}~I,,J.~ ..... ~.¢',~..~ ........... being duly sworn, deposes and soys that he is the applicant (Name of individual signing application) above named. He is the ....~.[;~,.~ ....... ~M;~.f.M,['~ ............................................................................................................ (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 a I statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed n the manner set forth Jn the applicat on f led therew th. Sworn to befp~., day ofme this ................. ........ ......... ............ .......... Notary P~" c~ ~~.,.~..,...L~~F~;~:"~ .......... ~'i'~nat~re of applicant) , Term Expires M. arct~ 30, tg~_~ ,