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Home My WebLink About3632-zFOK~I NO. 4 TOWN OF $OUTHOLD BUILDING DEPART/viENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..[~...~};~.3.4. ............ Dote ............... A. ug. tit{.~..~.v ................. , 19~o8... THIS CERTIFIES that the building located at ..... 13L].~..O=CB~Z'~..~O{~J .......................... Street Map No ....................... Block No ....................... Lot No ..... i~t:..ivla~;J.l~i,...Ne.~v...~'O,l~k ............... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. i{le, J~:l:~zaJ:l~r...2.].,.., 19.~.7.. pursuant to which Building Permit No..3.(~3~..~ dated ...................... J~.~D.~,lilllt];~'..~l e., ] 9...~..., 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 ........ ........................... ~t.o~.a~.. bu~l,l, clJ, ncj ... (~es~z~..ha ~l.d.~ng.). ............................................ The certificate is issued to ............... ~i~lill~.~...~.~C~Jl~EI ....................................................................... (owner, lessee or tenant of the aforesaid building. FORM NO. 2 TOWN OF SOUTHOLD 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) N? 3632 Z Dote Permission is hereby granted to: .................. ,.T. ~LG..e. :t.~ ~., ,e. ,a. ............................... ~ild ~eK &cce~so..~_Z ~u~. d~ma . . at premises located at ....O..~..~.....O....J~..~.~..J~......~..0.~..~. ................................................................................... ......................................... ij~ ..l~)~r ....11.,¥., ............................................................................ pursuo~¢ to application dated .................................. .~.~.~.....~d~ ....... , 19.~.~..., and approved by the Building Inspector. Fee $.~ Y.~... ............. FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S oFFICE SOUTHOLD, N. Y. ]9 ........ Permit No. ,.~(. .... Disapproved a/c ................................................................. ~ ................... / V ~'~guilc]ing I~ctor) Application No..~.~%-..;~..~;~. ...... APPLICATION FOR BUILDING PERMIT Date ............................ ~Je.~, ~llg~'..... P_,~, 19.65. ...... 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 issuence 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 demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. ~r s~...~Ta~e,S..Ge~c~es ...................................................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..~t~e~,..{).~;P_~) .................................................................................................................. 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 ..... I~.~d,..0~.O}~'~..~¢~..~t, ......... ~t,..~'~.$t;~t.....~.,.~., ....................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy .~D~r~;L~{] .............................................................................................................. b. Intended use and occupancy ....... 8~r~ff...W~L~..~..~.~O~..,l~l~i~ ......................................................... 3. Nat re of work (check which a plicable): New Building ...... :~ ....... Addition .................. Alteration Rep,~ir .................. Removal Demolition .................. Other Work (Describe) 4. Estimated Cost .... ,~.~(~..]~ ....................................... Fee ...~.00. (to be paid on filing this application) , 5. If cJwelling, number of dwelling units ........... ~.~.~. .......Number of dwelling units on each floor If g ~roge, number of cclrs 6. If )usiness, commercial or mixed occupancy, specify nature and extent of each type of use 7. Din~ensions of existing structures, if any: Front ..................... ~ .....Rear ................................Depth Hei ~ht ........................Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Rear Dep?h ................................Height ............................Number of Stories ................................ 8. Dimens~ons of entire new construction: Front ........... ~.~ .................... Rear .......~.~. ................ Depth ...... j~ .......... Heij~ht .................... Number of Stories ....... 9. Siz~of lot: Front ....~)0 ................. Rear ................. .'JOg ............ Depth .,.~,~ ...................... 10. DatJe of Purchase ........................................................Name of Former Owner 1 1. Zon:e.or use district in which premises are situated ....I.I.A,t.I...~[~.~ 12. Doels proposed construction violate any zoning law, ordinance or regulation? ........... ]~ .................... Narhe of Architect ...................................................... Address ............................................ Phone No. Na~e of Contracto~r .......... ,~lt~ ................................ Address ............................................. Phone No. PLOT DIAGRAM _ocat'e c ear y and distinctly a buildings, whether existing or proposed, and indicate all set-b~ek dimensions fr property I nes. Give street and block number or description according to deed, and show street names and indic whether in}erior or corner lot. STA-rE O~ NEW YORK, 1. S S COUNTY !OF ..... ~l~:~'m].]~ .......... ~' · · ................................ ..~,~....~..~;;,~.g.~,..g.~J.~.g.~.JJ ....................... being duly sworn, deposes and says that he is the applk j(Name of nd vidual sign ng appl cat on) abowe nerved. He is the ............ ..................... (~' .... (Contractor, agent, corporate officer, etc.) of said o~ner or owners, and is duly authorized to perform or have performed the said work and to make a.nd this application; that all statements contained in this application are true to the best of his knowledge and belief; that the ~ork will be per~ormed in the manner set forth in the application filed therewith. Sworn to ~efore me this ............. i ~]- day of ................. .~..~.'~.~ ................. , 19...0..~.. Notary P ~b I i c ,'-'..-~q. i~¢: .C~.. ·. ,(,~. r., j -- ~ARION A RE~ENT ,,~ ] NOTARY PUBLIC, Sk~te al New j No. 52-3233120 Suffolk C0ui;[~ j Term Expires March 30, ]~.~ of applicant)