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Home My WebLink About3425-zFOI~NI NO. 4 TOWN OF SOUTHOLD BUILDING DEPART/~4.ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .~..32~ ............ Date ........ &~U~i.~...27-, ........................ , 1 ~ .... THIS CERTIFIES that the building located at .-.530..~OO~l,~;~,~..~&Vtl. .................... Street Map No ....................... Block No ...................... Lot No. J~t~t;~..~lT, tZ~,~.,..~Ta...YO~7.1~ ....................... conform~ substantially to the Apphcohon for Building Permit heretofore filed in this offme dated ..................... ~:lz'.~L~.~ .......................... , 19..6.7.. pursuant to which Building Permit dated .......... ~;L.l.. [0, ...................... , 19.. 6.7., was ~ssued, and conforms to oil of the requirements of the apphcable provisions of the law The occupancy for which this certificate is issued is ........ g~ ~t,~r ~ 1; e,., ge~ age...(ecce sao=¥.. ~buzL 3. ~ltng ) ............................................................................. The cerhhcote is issued to Z~:a:r. at~e..&...q~t~[e~...~al/~kJ....(a,~ez::) .................................. (owner, lessee or tenant) of the aforesaid building. FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT CT'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3425 Z Permission is hereby granted to: at premises located at [ ~ ~C~lil~J%~ ~ , pursua~ to application dat~ ..'. ............................. ~.....~ ........ , 19.~,~, aod approv~ ,by the Building Insp~tor. ~ee $'.~'m ............. , BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........~.....j...~., Approved ........................................ , 19 ........ Permit No ........~...L..~...~...~....~. Disapproved a/c ........~.-;w~ ................................... ~ ........... ~ .......... Application No .......:~ .~y..~. ~,..'~T...... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a detailed description of layout of propertymust be drawn on the diagram which is part of this application. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whale or in part i~or any purpose whatever until a Certificate of Occupancy shall have been granted by the B0ilding Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance 6f the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions o[ alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. / ................................................ : ......... ~gnamre of appl~nt, or name, if a corporation} ........................................ ...... f~/'~ C C-~'- ~-- CG_c.~ c.~_,, i~$~ (Address of opplicant) State whether opplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and N ............................... .C.~...-~.../~...,~.. ............. ~ ......... .~..~,:)....~.....~..../...~..~.../.<. .............. Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy -' ' b. Intended use and occupancy ............... .~.~..,~...~...~... .................................................... ~.~ ............... 3. Nature of work (check which applicable): New Building .IK......... ....... Addition .................. Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ........~.. ................................................ 69.~., c~O Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, 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 .......................... Depth ............................ Height ............................ Number of Stories ............................................................................................................... Dimensions of same structure with alterations or aad't'ons Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ..........; ............................. 8. Dimensions of entire new construction: Front ...L..~. .................. Rear .../..~. ................... Depth .~ ........................ Height ....... ./~r...~..~.. ....... Number of Stories ..,/'.. ...................... 9. Size of lot: Front ...././...'~......'~.. .......... Rear ..././...-~..../J..~,.: ......... Depth . ./....J~...~....~.'.~./..~ ............ 10. Date of Purchase / ~ ~C~' · ........................................................ c~ame of Former Owner /~../...~'...~.......~...~....~..~.~.! ................. 11. Zone or use district in which premises are situated.....~..~....J'...~.'..~...~..A/..~..{...A....Z:. ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ..... .~/.....~ ......................................... 13. Name of Owner of premisesJ'..~.~...~...~.~.~..~.~./g.....~.ff..~'.,,~'//~ddress ..... J~.~...~..~../..~....~.~.....~.... Phone No./~....~.'..~.~.~..'~' Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor .~./~.,~.....~...~..C..~'...~.~...Address ,~.[.J.:..~..~.~...~.'.~./~. .......... Phone No./~.~....7.....~...//...~. PlOt DIAGRAM Locate clearly and distinctly oil buildin~ls, whether existing or proposed, and indicate all set-back dimensions 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 NE yg,RK, ,! ) S S "~'"' 'trqam~,of md~tion) being duly sworn, deposes *nd soys that he is the applicant above named. He is the ....... ~~ ......... ..~..; ..................................................................................................... (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; th-at all' statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Notary P/ , i,~ i'UBLIC, State of wYorl¢