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Home My WebLink About4912-zFOR~ NO. 4 TOWN OF $OUTHOLD :~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCI. IPANCY THIS CERTIFIES that the building located at .... ]~...l~t¢;l/~.q9.d......D.,~..;~.e. ................ Street Mop No. LS,.~,...P.k,.... Block No....X3~ .............. Lot No. ,..~,~,, ........ ~,~.12~.,e,~,.~....~...,~..~. ....................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................ A,~1{~......1.8 ................. , 19...~,0. pursuant to which Building Permit No...~.9.1.~'.. .... dated ......................... A~......1.¢) .............. , 19..~.0.., 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 ........ -..~.~.w~ t,e~ oz~e ...f. am:L3,y., nhc~;L;L~.zz/~ · ..................................................... The certificate is issued to ..~..'14~'ecl...~i;~,h ........ o1¢~1e~ .................................................................. (owner, lessee or tenant) of the aforesaid building. ~touse # 8h~O Building Inspectl FOR,M[ NO. 2. TOWN OF SOUTHOLD BUILDING DEFARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLIZI'ION OF THE WORK AUTHORIZED) N? 4912 Z Permission is hereby granted to: ............... ~;L:j.~'.e~.. ~, ........ , ........ : ................. ..... 11, · · .Oa.k"~e~. · · ~'i~' ............................................ .................... ;[,e,a~e.,1, ....... l/,,,~ ............................ to .......... ~ ..~..,~a~*~r~..~.. e~4~ -~t~e.~.:~l~lj .................................................... ot premises located at ............ ~.~. ........... ~11~,~t~...j~JJ~.,... .................................................... t .... .............................................. Jl.,.-.i~s~k~e~.*~ ............... ~l~et,--..-~l[.,.....~ ........................... pursuan* to opplication dated ............................. ,~t~ ....... JJL.., 19,..~1, and approved by the Building Inspector. 'J~WN OF SOfT, OLD BUILDING DEPARTMEN~ TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approve~ ........................................ , 19..~.~... Permit No..~...~'..L~..~ DiM~proved a/c ..... ................................................. ...,.,....~~ ~ ~... - (Building Inspector) ( APPLICATION FOR BUILDING iERMIT Date ...~ INSTRUCTIONS a. This application must be completely filled in by typewriter or in Application No. f~...~..L~.~X~. ......... ink und submitted in duplicate to the BuildinJ, Inspector. b. Plot plan showing location of lot and of buildings on premises, relati~nship to ad oining premises or public streets or areas, and giv ng o detailed description of layout of property must be drawn ~n the d agram wh ch is part of this app ication,~ 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 issueia Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progre~ss of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupanc¥O sha~J hove been granted by the Building inspector. · APPLICATION IS HEREBY MADE to the Building Deportment for the I~suance of a Building Permit pursuant to the~ Building Zone Ordinance of the Town of Southold, Suffolk County, New ~ork, end ot~her 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, ordlnonces,;b~..lld~ ~g~.eode, hou~g code, and regulations. ,,,~,. ~,,.~ ................ ,-~ .;~-, E/,e. ~? ................................................. (Signature cf applicant, or name, if a corporation) ......... ' '(Address of 'a'~'pll~l'~t) ...................... State whether applicant Is owner, lessee, agent, architect, engineer, genera! contractal~, electrician, plumber or builder. .......... · ............................................................................................. Name of owner of premises ..... ~.~,l,.~a..~,..~,~ ............~.~,~ ....... , ......................................................................... If applicant is a corporate, signature of duly authorized officer. '~ ............................................................ ................................ .... (Name and title of corporate officer) 1. L~atton of land on w~N proposed work will MunicI~li~ State existing use and occupancy of_premises and Intended use and occupancy of propps~ construction: b, Intended use and occupancy. .... ~t,~.~.~.~,~( ..... .~,~,.~,~.~,.~ ................ ~,.~X,~l..~.~ ...... 3. Nature of wo~k (check which applicable): New Building .................. Addition ~ Alteration Repair .................. Removal .................. Demolition .................. Other Work (Describe'~.~'~.~...~....~..~.~... ...... 4. Estimated Cost ....... .~....j.,..~....~?. ................................. Fee .......................................................................................... (to be paid on fi!lng 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. D m~nsions of ex?ing st'ructures, f any: Front ....~.~. ...... Rear ........ ~2 ................ Depth .......-~.~/. ....... Height ...... /..~.. ........... Number of Stories ............/. ................................................................................................... Dimensions of same structure with a.lterotio~s o.r additions: Front .......... ..~..~1../. ............. Rear ...~.'~..../. .............. Depth .......,~.~..: ............... Height ........... ./....~.../. ....... Number of Stories .............. I ................. · . , -~/ .~ 8. D,nens,ons ~o~/~nt,ru new construct,on: Front ........... /..'~ ................... Rear ...... Z.~.. .............. Depth ....... ~.. ............. Height ..... '.~..~ ........ Number of Stories ............/. ....................................................................................................... /- 9. Size of lot: Front ........... ~,../. ........ Rear ......... ~..~ .................... Depth ...... ~...?...~ ........... 10. Date uf Pu,'chose ...~.~.~.f.~.~....~.~.~. ..................... .~ame of Former Owner ..'~'.L~ ......... J.?-/.-).~.../C~....P...,~..,~. ....... 11. Zone or use district in ~hich premises are situated .../.'/~.5.L~.~.~...~...~l'~.~.b ......................................................... 12. Does proposed construct;on violate any zoning law, ordinance or regulation? ........ ..~.....~.. ........................................... 13. Name of Owner of premise~,',~t..~.~).~:~/,~..,~.~?~.~/ ...... AddressS~...~......~......O..~../~....~.'...~...q.~./~l~one No. ~.Z..~...../..~..~ Name of Architect ...................................................... Address ............................................ Phone No. ~..?..~...~..~.~ Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, end indicate all set-back dimensions from property lines· Give street and block number or description according to deed, and show street names and i'ndical'e whether Znterior or corner Jot. '' STATE OF NEW YORK, I. ee COUNTY OF ................................ ................................................................................................. being duly sworn, deposes and says that he is the applicant (Name of individual signing applicotion) obow., nomed. He is the ................................................................................................ ......................................................... (Contractor, agent, corporate officer, otc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that ail statements contained in this application are true to the best of his knowledge and belief; and tk~ar the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ........................ day of ............................................ , 19 ........ ....._~... Notar/ Public, . ........................................................... County .............................