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Home My WebLink About3417-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..... .1~1,.~[1...~..~.~.~ ........................................... Street Map No ....................... Block No ....................... Lot No .~j.~l.~.~.~...~..e~....~[.k.. ...................... conforn~s substantially to the Applmahon for Building Permit heretofore filed in this office dated ........................... .~.~...~..e.......3....4..,. ................. , 19..6.~.. pursuant to which Building Permit No..~l~,.~.g...~. dated ..................~..~..~..e........2..~..,. ................ , 19...~..?.., was ,ssued, and conforms to all of the requirements of the appbcable provss~ons of the law. The occupancy for which this cerhflcate is issued ~s ........ ..... l?.~.v..~.~....qO~..~k~...~.e,~,J, ug ......................................................................................... The certificate is issued to ......... ~.~I~...~..,.....C.~.K[AL.I~ ...... [~/~.~.) ................................................. (owner, lessee or tenant) of the aforesaid building. Building Inspector J TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No...~.....3..],...[..0.. ............ Date ...................... 3:.une ....... ]-l, .......... , 19.68... THIS CERTIFIES that the building located at ~,~I..I~..~Q~J ................................................ Street Map No ....................... Block No ....................... Lot No ....l~....~..~..~.~..~...c~...t...~..e~.,...~.O..~.~ ...................... conform~ substantially to the Apphcation for Bu;Idmg Permit heretofore filed in thru office dated ............... ~.~..~.. ....... ~.7.~. ....................... , 19..~..~.. pursuant to which Building Permit No..3.4,~.?...~ dated .......IJ~...~..~...~. ...... ..~.~ ....................... , 19...~.~.., was ~ssued, and conforms to all of the requirements of the apphcable provisions of the law. The occupancy for which this certificate is issued is ........ .......... p~ ~.v..~.e... ~ .e..e...e. ~.~ .o..z. ~....b..u..~ ~ ..d.~.n..~....(~ ~.o.~g..e.....~..h..e...d.~ ................................................... The cert,fJcate ,s issued to ....~..~...a...t~......~..?....C...a..~...~..~..~. ........ {...o~....Tl:..e...~.). ...................................................... (owner, lessee or tenant) of the aforesaid building. FO~ NO. ~ 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? 3~17 Z Permission is hereby granted to: ........... ~..aoaa. ...... .~..~:,],.8..~ .................... .................. ~att~t~k ....................................... ~o .... ~...~.....u..%..~...t.~...~...~..o.~..a.i[t~.a_~..~..o...z'Z.)...~ .................................. at premises located at ...,.~...~.....l~....,l~.. ......................................................................................... ~1 ]{.~. pursuan¢ to application dated l~reh ~ 19...~..?., and approved by the Building Inspector. .................. ~ii~l;n9 Inspector / FORM[ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... ...... Approved ........................................ , 19 ........ Permit No ............................... Disopproved ~/c ........~ ...................................................................... (Bu~ldm~ Inspector) INSTRUCTIONS a. Th~s application must be completely filled m by typewriter or in ink and submitted in duplicate to the Buildlr Inspector. b Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets areas, and giwng a detailed description of layout of propertymust be drawn on the d~agram which is part of this applicatio c The work covered by this opphcation may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector wdl ~ssue a Building Permit to the applicant. permit shall be kept on the premises available for ~nspection throughout the progress of the work. e. No building shall be occupied or used in whole or ~n part l~or any purpose whatever until a Certificate of Occupan, shall have been granted by the Building Inspector· APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to fi Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein describe The apphcant agrees to comply with oil applicable laws, ordinances, buildi. B. g code and regulations. (Signature of applicant, or name, if o corporation) (Address of appli~n[i''~ ................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electncian, plumber or build~ Nome of owner of premises ..... .~..'~...'~....~.....,~....~......~...~.~.~.....~../../z~... .................................................................................. If applicant is a corporate, signature of duly authorized officer. (Nome and t~tle of corporate officer) 1. Location of land on which proposed work will be done. Map No' . ........................................... Lot No' . ................ Street and Number Z~.~..2..~....~...~../?...~.....C~.~...~.~...7../...~.f./...¢....,~.. ....................................................................................... Mumcipality 2. State ex~sting use and occupancy of premises and ~ntended use and occupancy of proposed construction: o Existing use and occupancy .. ~....~....~.....~.~.....~.....d:~....~....~.~...~r.. ................................................................................. b. Intended use and occupancy ..... ~..~.....~....~....'~..~. ........................................................................................... 3. Nature of work (check which applicable). New Building ....... .~......... Addition .................. Alteration ................. Repair .................... Removal .................... Demohtion .................... Other Work (Describe) .................................... 4. Est,mated Cost .............~/.i..'..'./....~.....d. ............................ Fee ........................................................................................ (to be pa~d on fihng this applicQtion) 5 If dwelhng, 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 ...... .~../..o....,~...~.~ ......... 7. D~mensions of ex~sting structures, if any: Front ...~....~...~..~ ........Rear ....~....~...,:~...~.. ........ Depth .....,~'...~...~..¥-.-. ........ He,ght ..../~...~...'~..~.-. .......... Number of Stories ..... ~.~...~....~.~. ..................................................................................... Dlmens,ons of same structure with alterat,ons or add,t,ons' Front ..... ..~.....~..../~....~.-.. ........ Rear ...... ..~....~....~..'..~.. ....... Depth .....~...~.../~....z..~.. ......... Height .....~...¢...o../.~....~.. ...... Number of Stones ........................................ 8. D,mensions of ent,re new construct,on' Front .... ~...~......~..~ ..... Rear ..... /..~....~.......;~.. ..... Depth ....... ~......'~...~ Height ....~'......./~......~... ..... Number of Stor,es .... ./.~..~...~./...~.. ........ 9. Size of lot Front .....~'....~.......~.-...~... .... Rear ..../...m~/.....~.~....7~'... ..... Depth ......?..~...~......~.......~.. ..... t0, Date of Purchase ..... ~./......~'/..~.....7.. ................... Name of Former Owner .f,~....,~....~...~...~..~....,'~..%.~...~..r~.., 11. Zone or use distr~ct m which premises are s~tuated ............................................................................................... 12. Does proposed construction violate any zomng law, ordinance or regulation:) .... .~....~.. ...................................... 13. Name of Owner of prem,ses ....~./(~...Z?..~.....~...~.~;....'~....Z~.rfr/(ddress Z~f.~/...~..,d~..~.,~'..~.../~ .~..7'.~"~....~.'~one No. 4~,~..r..~.....~..~. Name of Architect ................ .,~....~.../~...~...~. .................... Address ......... .z~'...i.¢'..../~.....~'.. ................ Phone No .... .~....~...~..~'..~ Name of Contractor ............... ,/..l.....Z~.../O ~- ....................... Address "---" Phone No ................... ~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fro, property hnes Give street and block numbers or description according to deed, and show street names and ~nd~ca~ whether ~nter~or or corner lot. /L.J l~i l tq [~.o ll tO STATE OF NEW YORK, '~ S S COU~,,~~NTY~,OF .......................... :~.f ' · .... ~~ ...... ~,~ .................... being duly sworn, deposes and says that he is the applic~ (Name of ind,vidual s~gnmg apphcation) above named. He is the .................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of sa~d owner or owners, and is duly authorized to perform or have performed the smd work and to make and this apphcation, that all statements contmned m th~s application are true to the best of his knowledge and bell and that the work w~ll be performed m the manner set forth in the apphcation filed therewith. Sworn to before me this Notary Public, . ........................................................... County (Signature of applicant)