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Home My WebLink About8284-zFOB,M NO. · TOWN OF SOUTHOLD BlffLBING DEPARTMENT Town Clerk's Office Southold, N. Y. ,/ Certificnte Of Occupnncy THIS CERTIFIES that the building located at .~-..._-~-~o .~... ~.. Street conforms substantially to the Application for Building Permit heretofore filed in ~ office dated~~/f~. 7 ...... , 19~.-~. pursuant to which Building Permit No.e .;~:..q.~---- / dated~L.~,. ~?'?.. ~. lAY..~ .... , 19~}.~., was issued, and conforms to all of the require- ments of the applicable provisions of the law. The occupancy for which this certificate is issued is~f,,t,;...~.. 0_~,~...~'~r.~.~. ~.:.~ '~' "l' ~J'~' '(~'~*~'''' '~ ~t~f] The certificate is issued to ' ' ' ~.~' Oj'~.:x..~ .......................... (owner, lessee or tenant ) of the aforesaid building. Suffolk County Department of Health Approval ./4] ~..2-, .......................... HOUSE NUMBER .... ~'g'O · ' ' Street...~>~.~_.. ~ .~~.~.~ FORM NO. 2 TO~N 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? 828 Z Date ....................... ~-o~. ............ 7 ............ 19..~.[~.. Permission is hereby granted to: ......... .~..o...u..t.~.~.L~ .....~i,..'.~., ..................................... to ..~l~...~.~....a...~i~i.~n...ar~..,~i~ti,.~.,...~.;,:,~:.;.~n~ .............................................................. at premises located at ....LD.%..J~ ............ ~.ea:~:~z~...,~aL'/.~.s ................................................................. ......................................................... wD.~.~...,.~i..~. .......... ~u.%...!~ .............................................. pursuant to application dated ..................... t.",~ ....... -~ .................. , 19r~...., and approved by the Building Inspector. Fee $...1..~.o~0 .......... / ~ Builc~ng Inspector TOWN OF SOUTHOLD Building Inspector's Office Town Clerk Building Southold, N, Y. 765-2660 I'r'~,~,~'"'~-.. ~ TOWN CLERK'S OFFICE I/~lJ ~/' ~UTHOLD, N. Y. .............. ......... ........... ................ ......... .......... . ,,:_ ............................................ ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT Date .................... ~..../. ........ , INSTRUCTIONS ]-his application must be completely filled in by typewriter or' in ink and submitted in triplicate' to the Building tar, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets or and giving o detailed description of layout ofproperty must be drown on the diagram which is port of this application. The work covered by this application may not be commenced before issuance of Building Permit. Upon approval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit De kept on the premises available for inspection throughout the work. No building shall be occupied or used in whole or in port for any purpose whatever until (3 Certificate of Occupancy ,ave been granted by the Building Inspector. 'LICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the ~g Zone Ordinance of the Town of Southold, Suffolk County, New York, end other applicable Laws, Ordinances or ~tions, for the construction of buildings, additions or a~terotions, or for removal or demolition, os herein described. ,pliccnt agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and to authorized inspectors on premises and in buildings for necessary inspe~,.ions. .......... . .~/./i . ,,_,~.. t_,: _, ...... (Signature of applicant, or nome, if a corporation) ............. .,~.C...~...~r..C ~'.5:f~....T..,~ ~.i;.~?~..~.... ~; ........ :... (Address of op~;licont) whether applicant is~, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. :.:cant is a corporate, signature of duly authorized officer. .............................(Nome and title: ................................ of corporate officer)" ............... _ . ;u'lders License No. ~ ~p ~'~l .................................................... dumber's License No ................................................. :lectri¢ienq Eicense No, ,.: .................. , ...................... ]ther Zrade's License No ............................................... ~ x~-,-r--~'( ~--'-'~1. A/~ 7~ Location of land on which proposed work will be done. Map No .................................. at No ......................... Street and Number .:....: ................. ?...E...~....~....o...o...b........~.....~..!..~..~ ............... ~ .................................. '~' = Municipality State existing use and occupancy of premises and i,p:ended use and occupancy of proposed construction: j ? o. Exisiting use and ocr4Jpancy /~ m; 1-' b. Intended use and occupancy . ~./YJ.-~...'.... ................................................................................... 3. Nc re of work (check which applicable): New Building' · ................. Addition .,~... ..............Alteration ................ Repair-. ................. Removal .................. Demolitio~ .................... Other Work ................................................ . .... (Des, cription) 4. Estimated Cos;~ ~_0~0 ~- r~ / (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 b'pe of use ...~ .............. 7. Dimensions of existing structures, if any: Front ............................ Re~ ................................ Depth .................... Height ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear Depth ................................ Height ............................Number of Stories ................................ 8. ~imensions o{ entire new construction: Front ............ ~ ................... Reor ............................ Depth ...~ ............ Height ...~ ............. Numbs[. of Stories ...................................................................................................................... 9. 'Size of lot: Front ........................................................ Rear .......................................... Depth ................................ 10. Dote of Purchase :: ......................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... ~.~.~.f.~r~.(~.~.¢/~..~ .......................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation: ........ ~.~...~ .................................... 13. Will lot be regraded ...... .~g ............... ~ill excess fill be removed from premises: (') Yes (~) No 14. Name of Owner of premises ~0~1~ ~'~ Address~u°o~ ~ PhoneNo. Nome of Architect ....................... ~.~.~.~ ......................... Address ................................ Phone No ....................... Neme of Contractor ....... ~..~.~.....~.~.~..~.~.~..~.~ ......... Address ................................ Phone No. ~.~.~.~. PLOT DIAG~M Locate clearly and distinctly ali buildings, whether existing or proposed, and indicate all set-~ck dimensions from prope~y lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. , ~ZATE OF NEW JOR~'- ~'~,'~ -~ t S S COUNZY OF ..~~~.~ ' ................................................................................................. being duly sworn, deposes and s~ys that he is the (Name of individual signing contrac~ above name. 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; that a~l statements contained in this applicotion are true to the best of his knowledge and belief; and tha~ the work will be performed in the manner set fo~h in the application filed therewith. Sworn to--ore me this ~ 1 ...... ........................................... ~ -~- - ~ ~ / (Signature of applicant) J~DITH T, ~OK/N Ho. 52-0344963 Suffolk Coun~