The URL can be used to link to this page

Home My WebLink About173-zFORM 1~), 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD. N. ¥. CERTIFICATE OF' OCCUPANCY No... ~..?~1,4 ...... Date ....... ..~Ul~ ~8 ..... , 19.60 THIS CERTIFIES that the building located at .~/~ ~e ~9~. ~.~,... S~9.~9~treet Map No ........ ~ .Block No. . ~ ..... Lot No. P*~ ............................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............ ~.~.fl~ .~5.., I~X... pursuant to which Building Pemit No ..... ~ ~3 .. dated ............. ~~t ~5- , 19. ~, 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 This cert~cate is issued to . . . ~~d a Etla~ .~~, ..9~ . . (owner, lessee or tenant) of the ~oresaid building. Building Inspecto~ ' FOR~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FUU COMPlETiON OF THE WORK AUTHORIZED) No - .7. "~3"' Dante ..... ]lov. emi~er .~L~. ................. 19~.... Permission is hereby granted to ....... · P4.ae n~. l~d .......................... ........... Southet'l.d t ..... 1~, 4, .................... to '"B'mt~d ne~ dwe'lt~ ........................................................................................... at premises located at N/'~ ~P:l~e. Neck ~o~I ................................................... ...................................... IBoutho:ld~ .... I~,.Y., ............................................................ pursuant to applicatmn dated .......... NOV~'~I~I'"'""-~: ............ 19 ~'~, and approved by the Building Inspector Fee $.~,,~t.. i~o o FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. f Approved ........................................ 19 ........ Permit No ................................. Disapproved o/c ..._.....6:;;~,~:: ........................................... ~: ....................... 7' (Building Inspector) Application No APPLICATION FOR BUILDING PERMIT Dote ................... ........... INSTRUCTIONS o. 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, relotionship to edjoining premises or public streets or oreas, and giving o detailed description of Ioyout of property must be drown on the diagrom which is part of this location. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon opproval of this opplication, the Building Inspector will issue a Building Permit to the applicont. Such permit shall be kept on the premises ovailable for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until o Certificote of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, end other 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, ordinances and regulations. (Signature of applicant, or nome, if a corporation) ......... ....... ............................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrican, 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 ................................... Block ....... ~ ........ .. ................ Street and Number ./~.../7../..~.. ........ ...~..~...../...~...'~....~...~.. ......... ~...~2.....~... ................. ~...,~.....~. ........ State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy ......................... ~ ........................... i .......................................................................... b. Intended use and occupancy .................. .~[ ...................................................................... 3. Nature of work (check which applicable): New Building .................... /'/ Addition .................... Alteration .................... - Repair .................... Removal .................... Demolition. ................... Other Work (Describe) .................... 4. Estimated Cost ..~....4..~ ..................................... Fee ...L..O... ............................... (to be paid on filing t'~i~'~ii~'~¥i~')' ................... FEES: / If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ........................................................................................................................................ 6. If business, commerical 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 additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions~of ~?i,~ new construction: Front ......... .'.-~....~.. ........... Rear ......... .~'.....~.. .......... Depth ~'" Height ~' Number of Stories /~' ............................ 9. Size of lot: Front ....... ./.'....~...Zr. ....... Rear .....J...~....~:.~..?....~.! ..... Depth ...../....~..?....-~... ......... 10. Zone or use district n whch Dremses are situated Z.."~.. ~ ...... ~.~..... .............................. 1]. Does proposed constructiot~ v;olate any zonincl law, ord;'~'~ ~;' 'i~;~;~;;~;' ................................................... 12. Name of Owner of premises.....~...'...k~....~..'...~Address ............................................ Phone NO ..................... Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor ......... ~ .................. Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, 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 NEV~ YORK, COUNTY OF.~.,~- ~ ' /~f rvc~¢-~z- /~ ...~:~....~.....-~.~..~~ ..................................... '.beiflg duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ~--r,.,,j~,,,~_,,,~ , . (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 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. Sworn to before me this ........... J..~ .... day of ........ ~ ...................... 19...~..". 7.. Notary N'otmy Public, State of New York Residing in Suffolk County No. 52-0367500 My Commissio~ Expires March 30, ~ ' (Singature of applicant)