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Home My WebLink About3557-zFORM NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTtIOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Z. 2830 .... Date ............. .~ept. · .6 ......, 19 ~5~. THIS CERTIFIES that the building located at E/8. A.~ahmnomaque .Ave .... Street ~p no~X~n. ~to~k ~o ............. ~o~ ~o..~ ....... $.~. ~.~a.. ~.~, ..... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... ~ .... 2~. , 19.6~. pursuant to which Building Permit No..~ .~ dated ............ ~.. 2~.., 19.~, was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is issued is .. P.~ivalo .one. -f~.i.~y. d~elli~g ..................................... The certificate is issued to . Mi~lia~ .8ia~dSey ..... 0~ ........................ (owner, lessee or tenant) of the aforesaid building. Suffolk County Department of Health Approval ........ ~,~, ...................... Building Inspecto~ · FORM NO. 2 TOWN OF SOUTHOLD · BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N?r (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FUL~ COMPLETION OF THE WORK AUTHORIZED) Permission s hereby granted'to: I,,..~'...~.. ~ ~...7~ ....A/~.....~.... ltt, a~Llejr ............... ~.~,~a~: .......................................... to ~u~.~ ..~..~I~.~1or~ ..o~:.~...e~.~x~4L .~.~.,:tl ~..,: ....................... ~.~ ....... ~ .................. at premises I~ated at ..:Lc~'~: ]~g~.....~:~:~..~.%~L~:e.~ ............. : .......... 2.L.~...;;L ................ L..J ........ .......... ....., ....... '...~.....~~..~ ........... ~A~ .......... ...~:..: ...................... ~....~ ...... 19..~,: &fid opprov~;~y the pursuon,t to, application dated ,. ........ i.J .............. ~.x~ ............ ~ ....... , Building, Inspector. Fee $.~.t...Og.. ............. FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~'VN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... , Approved"" ', 3 ........................................ , 19 ........ Permit No.' Ding,Drayed ~/c ............ ~ ................................... ~.~.....~ ........ ~....~ ....... ............ ........................................... (~ildi~spoctor) APPLICATION FOR BUILDING PERMIT Date ................................... .'J..?..~...~. ....... ~.?...., 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, end 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 Lows, 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. A. Reilly & Sons Inc (Signature of applicant, or name, if a corporation) ............... .Iv.I~ .~.t.j..¢.UC k ............................................................ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ........................... .............................................................................................................................................. Name of owner of premises ..!~.TR,...~...~.~,,-q~.~. ..................................................................................................................... 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.: ..~a~±~LQ~..~.$.~ ............ Lot No.: ..~2 ................. Street and Number ..~.~.....~.~.~2[~'.~...~.~ .......... ~.9.~.~.~ .................................................................... Munici~lity 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 ~cupancy ........... ~.G~..~{~.~...~,~..~,~.~.9~ .................................................................... 3. Nat]ute of work (check which applicable): New Building .................. Addition ....... / Rep,Jair .................. Removal .................. Demolition .................. Other Work (Describe) 4. Esti~nated' Cost ..~.%0.0.0.....~.Z.~. ..................................... F'ee ~.00 (to be paid on filing this application) 5. If ~welling, number of dwelling units .....o...~..e. ................. Number of dwelling units on each floor If gbroge, number of cars 6. If I~usiness, commercial or mixed occupancy, speci.y rat e o d ex ent of each type of use 7. DiMensions of existing structures, if any: Front ............................ Rear ................................ Depth Hei~lht ........................ Number of Stories Dimensions of same structure with a,lterations or additions: Front ....................................Rear De th ................................ Height ............................ Number of Stories ................................ B. Din ~ensions of entire new construction: Front ..... ~,~ ........................... Rear ..... .2...2. .................. Depth 30 Hei;~ht .................... Number of Stories ........ 9. Siz~ of lot: Front ............................ Rear .................................... Depth ................................ 10. Do~ of Purchase ........................................................ Name of Former Owner 11. DZoO~se ~;o~;:eddisj~t;~ ~iihoinChv :[ae~i~enSyazr;n~it~ewd ................... !~!!~ ~!~.i. ...................................................... : .................... 13, Na~e of Owner of premises ..~T0...,S.t:;..~..~..(.1..]:.e,.~. ............ Address ........... ~.O...~.~,O. 1. ................. Phone No. Na~ne of Architect ...................................................... Address ............................................ Phone No. Naive of Contractor ~..,...~D.$11~...~.'....~.,O.Z~P.....Z..D.~.....Address -~isisz'b~C!4: Phone No. PLOT DIAGRAM I_ocat ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property nes. Give street and block number or description according to deed, and show street names and whether interior or corner lot. STATE O~ NEV~ YJDP, K. 1 S S COUNTY iOF .~.z_z...o..z.'~ ...... j ....... ~ .. ................. ' ................................................................................ being duly sworn, deposes and says that he is the appli( j(Name of individual signing application) abow~ ncr~ed. He is the Coz].¢z'~ct;oz' , (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 this opph~ahon; that all statements contamned in thru application are true to the best of his knowledge and belief; that the wprk will be performed in the manner set forth Jn the application filed therewith. Sworn to efore me this ................ i...~,~day of ................. ~.....~.~.Z ......... , 19 ...... ,~q /'~ ~ '~/~ (~ ~e, 52-3233120 Suffolk Count. y~ ,'Term Expires M.arch 30, 19.~