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Home My WebLink About4853-zTOWN OF SOUTHOLD! BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCIJPANCY No. ~...3.~8.~. ............. Date ............................ ~¢p.t, ....... 25 ...... , 19.-.70 THIS CERTIFIES that the building located at ....~/~..~O'~rO'C~...~E ................................ Street Map No ..... ~f~ ............. Block No ...... ~ ............ Lot No. '~z.JJ[ ....... ~)~he'~.~'""~-'Y'~ ................... conforms substantially to the Application for Building Permit ': heretofore filed Jn this office dated ............................... '~l~]j~ .......... ~ ........... , 1¢)...~.0. pursuant to which Building Permit No. dated ...................... 'J12[~ ......... ~'~J .......... , 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 ........ .................. · ~c~e~so~'T .b~t~g' 'l~ s~o~ge.) The certificate is issued to ....~?~.~..Ge~..~ogO~a~ .............. ~$~ ................................................ (owner, lessee or tenant) of the aforesaid building. / ............ ~,,~..~.,~,,~.~ ...... .~, ........ ~ ................. ~ .............. ' Building Inspector FOR¢~I NO. 3 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE ' SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISE,S UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 4553 z Permission is hereby §rented to: ............. ~.~.~...~.~.,...ltt~m~ .......................... ............... ~,~..~ ....................... ................. .................... ~h~¢t ........................ ................. to ....... ~u$~..~.~.~,~....~..~.~.~e...~t~ ................................. at premises located at ........................ .~, ./..~.,...~.~.O.f}.~,,.,~g~., ......................................................... ........................................................................ ~utho;t~l.....' ....... ......................................................... pursuan,t to application dated ............................... J~. ....... ~J~..:....., 19...~.(~, and approved by the Building Inspector. lrO~M NO, I ~) TOWN OF $oUTHoLD q~ BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined /~::) 19 ? ~) Application No Approved ..... '...~. ............. , 19..../.!.. Permit No. ~/'(~' '~''~ ~'. Disapproved a/c ................................................. APPLICATION FOR BUILDING PERMIT Date ...................... /......... ........................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink und 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 nat 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 whole or in part far 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 iss,~ance of a .Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New Yo.k, and othe, applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations. (Signature cf applicant, or name, if a corporation) ............................. ............... ........ ............................. (Address aT applicant) -- State whether a,Rplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ............ ~..~.?.....;~....~:.;........'~.?.'!...~.'.;~..~..~..'~. ................................................................ If applicant is a corporate, s~gnature of duly authorized officer. (Name and title 'of corporate officer) ~ ,~ ~ Location of land on which proposed work will be done. Map No.: ........................................ Lot No.: ......... ~ ............ r-- ..................................................... ...................................... Street and Number : ~.~.~..:~. Municipality State existing use and occupancy of premises and intended use and occupancy of p)'~posed construction: a. Existing use and occupancy .............. ~~..:,x.",:,=~.~,:: ....... : ........ ~.:::..:.. b. Intended use and occupam; .............................. .~.... .................................................................................... 3. Nature of work (check whici~ applicable): New Building .................. Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .................. Other Work (Describe) ........................................ 4. Estimated Cost ............... r ....... ~. ................................... rea ......................................................................................... (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 tTpe of use ............................ 7. Dimensions of existing structures, if any: F~ont ...........~..~.~..~. ......... Rear ~ / Depth Height ........ /..,~. ........... Number of Stories ................................................................................................................. Dimensions~z/~.~,,of sar~? structure with alterotions,~ / -- t,-°r additions: Front ...... ~.....~.... Rear ...~/.~./.. Depth .....~ ............. Height ...:.~/..".-.~-...~' .......... Number of Stories ~ ............... 8. Dimensions of entire new construction: Front .......... z~..../.'..~..../,x, ........... Rear ...... ~......~....~ ...... Depth ........................ Height ~ ! O ~/ Number of Stories · 9. Size of lot: Front ..... ~..~..~....x...~..~x.... Rear ..... .l..~....~....x.:....~..~ ....... Depth . .~..(? .... 10. Date of Purchase ...~.,...~..,.~..~, .~.,. ......... Name of Former Owner '"~' ! 1. Zone or use district in which premises ore situated 12. Does proposed constructlon ~iol~te any zonin_~ law, ordinance or regulation? ...... ~ ................................................ ~'?/~ ~ 9'~ ~-------~,.~,.. J~J~..~ ~-~o~'.~4.~_ Phone No..~...~..~.~.~ 13. Nome of Owner of premises ............ : ........................... Address .................... : ..................... Name of Architect ...................................................... Address ............................................ Phone No ..................... Name of Contractor ........ .Z.?..~...~.......... ............... Address ......~.~.~ ......... Phone No. .................... ,~,~-~--4.~ PlOT DIAGRAM Locate cleorly end distinctly all buildings, whether existing or proposed, ond indicote all set-bock dimensions from property ~ines. Give street ond block number or description occording to deed, and show street names and indico~'e ~hether interior or corner lot. STATE OF NEV~O,~ J~ COUNTY 0 F .':,,~./.,~F-.~cG~ ............ ~' ""~' ....................................... :~~ ........................... being duly sworn, d~oses and says t~t he is the applicant (Name of individual signing~pplication) above named· He is the (Contractor, agent, co~orate officer, etc.) of said owner or owners, and is duly authorized to perform or hove performed the said work and to ~ke and file this application; that 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 fo~h in the application filed therewith. Swam to before me this ..... ...... · o, ......... ............... hiatus/ Public ~ _. [LIZAB~H AN~NEVlLLE NOTARY PUBLIC, Sta}e of New York Ho. 52-8125850, Suffolk C0~ Term ~pi~es