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Home My WebLink About3583-zFOEI~ NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No..~...A~.~3.0. ............ Date ...~tg. Ul~.t,..~,.~, ............................. THIS CERTIFIES that the building located at ...~.~t3.~ft..~5 ................................................ Street Map No ....................... Black No ....................... Lot No...Oz~Lettl.t,...l~,f~[,...EeW...Yl~,l[~ .............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................... .~..~.g~..~..t,.....2...5.~ ...................... , 19...~?.. pursuant to which Building Permit No....3.5..~..3.....~. darted .......... .~...~.c~...2...5..,. .................... , 19.6...?....., was issued, and conforms to o~l of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ............. g,r.~y.~.~.e....o.b.e....~.a~'L.l,y... ~.e 11,1,rig .................................................................................. The certificate is issued to ............ .T~]~.~..~e;~/).8 ......................................................................... (owner, lessee or tenant) of the aforesa, id building. · ' Building i~pector ..... '[" FORM NO. 2 TOWN OF $ou'rHOLD 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) 3583 z Permission is hereby-granted to: .... ~.~.~... ~L~ ~;L~;a....~.c. ....... .~,...~.~. ..... et premises located'at ~,'~.~.2,~,..[~,,0.~.....{~.~ .................................................... ~ ............................ . .... ; ....................................... .v.~,~,~ ~.....~. ~ ~.,. ..................................... :,..; .................... ; .............. : ..... pursUan~ to application dated ............................ .~.~.~..~..~.....~. ........ , 19,~.., and. approved ~y the Bhilding Inspector, ~ '' ' Fee $ ........................ Budding Inspector 'f ~" '" '" FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×am,ned ..... ....... , Approved ........................................ , ........ Permit No .......................... Disapproved a/c ~.~~..L::~.~~m:..~... :'~' ....... Application No. "? ~(~°L~'~ APPLICATION FOR BUILDING PERMIT Date ........................ ~...-.~......~.. ........,19.(.i?. .... 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 thb 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY M~,DE 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 regulatj~ns. "' ' ' ....... ~' ( igno~/-~'e pp 'cant, or nome, if a corporation) j~//r ..,~ ~. () ~ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ome o{ ownor o{ premisos ................................................................................................. 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.' ........................................ Lot No.: ........................ Street and Number ...;~...,..~.~...~.~."~. .................................. ~~....~.~..,.~ ..................... 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 .--(~--~L · 3. Nature of work (check which applicable): New Building .................. Addition .................. Alteration .............. Repgir ................ .),(~.,emoval .................. Demolition .................. Other Work (Describe) .................................... 4. Estimated Cost .....~..~..~..O..,...O....~.. ................................... Fee ...................................................................................... ~ (to be paid on filing this application) 5. If d~elling, number of dwelling units ............................ 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 ..... .~....~......~.. ......... Rear ..... .~....z~...~...~...,..,. ........ Depth ....~....~...~..~.'..~ ....... ./,e. .............. Number of Stories ........... ~. ................................................................................................ Height ~ Dimlensions of same structure with a.lterations or additions: Front .......... ~..../'Z'..~..~....~:. ........ Rear ..... Depth ...... ~....'~......~.. ............ Height ......./....~.. ............... Number of Stories ..... ./. ......................... 8. Di4ensions'~ of entire new construction: Front ........ ~..~...'...~....~.~ ........... Rear ...... .~...(-/..~.~..:[.... Depth ..../..O....f ....... Height-- .....~....~. ......... Number of Stories ................................................................................................................. , / '2ft o r 9. Sizd of lot: Front ....... /..Z£..'......... Rear.................................... Depth ................................ 1 1. Zon~e or use district in which premises are situated ...... ..~CX..~4..; .......................................................................... 12. Doe proposed construction violate any zoning law, ordinance or regulation? ...~ t3. No,~e of Owner of premises '/.4), ./.~ .............. Address .....~~...~.... Phone No~ Nat ~e of Architect ................................. ,~ .................. Address ......... ............ Phone No. Narhe of Contractor'7'.~..:.~.~~~' ........ Address LZbz'"~---z'~t--~ Phone N PLOT DIAGRAM Locotb clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property I nes. Give street and block number or description according to deed, and show street names and whether in :erior or corner lot. STATE O~ NEW ,yORK ..... / c c COUNTY IOF .....~...,-2'...,eT....,~..~.~....~Z....,f .... ....... ~ J(~me of individuo~appli~ion) above no~ed. He is the ..... ~~ ................ (Contractor, ogent, corporote officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make and this oppli~ation; that all statements contained in this application are true to the best of his knowledge and belief; that the wprk will be performed in the manner set forth in the application filed therewith. Sworn to ~efore me this .... Z~.. day of ...~~ ........... ........ C Notary/Public ~~..~~~[-~.~,....~,~ountyS ..... 7( ~"tnotu e o~ applicont) ~ ~OTAR~ pUBlIC, STaTE,OF N~w lu~ /. -- 4/52.7306925 SUFFOLK COUNTY "~ ' '/) ) ' ' ':'~ ~J/~",~/L(' Commission ~xp~res March 30, 1968 ,'~ ~ - - "; ' ' ' ) '.