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Home My WebLink About449-zFORM NO. $ TOWN OF SOLITI-IOLD BIJILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Date ............f...] .............................. :z~ ....... , 19 ........ THIS CERTIFIES that the building located at .................................................................. ~tree~t , ....... uTCh o G uc - M~p No ......................... Block No .........................Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......................................................... 19.'"..'C.., pursuant to which Building prermit No ............................. T' dated 197....~..t was issued, and conforms to all of the requirements of the ap.~licable provisions o,~the law. The occupancy for which this certificate is issued is .............. (owner, lessee or tenant) of the aforesaid building. FOEI~ 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 FULL COMPLETION OF THE WORK AUTHORIZED) N.° 449' Z Dote .................... ~p~;~lJ~F- ............... 19.~.. Permission is hereby granted to: lCid~lez & Horten-...- '~'C'""ett-f-~ord...t~ter .................... ................ ~tttehe~ue ......................................... .............................. N.,.Y., .......................................... to ....... lmI~d'"a"~l~t~I$'~"~ge .................................................................................................. ot premises [ocoted ot **g/8*'~eh~o~l'**g*t"~t.~:ent, Ion .................................................................... ........ : ........................................... Cutel~jue ;. ....... ll'~.~ .................................................................... pursuant to application dated ......................... ~t~'t, IB~IMJ'I'"'"']~ ....... 19.~'j~.., and approved by the Building Inspector Fee $'lO~O(~'"p:ald Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD', N. Y. Examined......~Z....~.~..... Approved ........................................ 19 ........ Permit No. ~....~....~../...Z ........ Disapproved a/c .. .~.~...~ ..... L ~ ........... ........ ........ i§',~'i'l',~'i;'~"i;~'~;~';;i ................ '[ ............. APPLICATION FOR BUILDING PERMIT a e ........... .'~.. _. ~'~m ~. ................................ -...,~... 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 property must be drawn on the diagram which is part of this location. 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 whole?or in part for any purpose whatever until o Certificat, e of Occupancy shall have been granted by the Building Inspector./~ · 3:~1: /" . . . APPLICATION IS HEREBY MADE to the Building Depc~rtment for the ~ssuanc,e of a Budding Permit pursuant to the Bud ng Zone Ordinance of the Town of Southold, i!~,uffolk~,County, New York, and other applicable Laws, Ordinances or Regu arians, for the construction of 'buildings, addih~?ns %~ a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable i~ws/'orSinances and regulations. (Signature of apphcant, or name, if a corporation) ............... ......... ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ....................................................................... Name of owner of premises .............................~'! ./../~/ .................................................................................. If applicant is a corporate, signature bf duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will begone. Mop No: ...: ..................... ~ ................ .~,Lot ~p: .~ ................. St reet and N umbe r ..~...~..~..~....'.~..~..~.....(~,. ... ~.(>.7~....~.. .... ~. ..........~.~.. ~x~. ~' .~.........-~.... Municipality 2. State existing use and occupancy of pr, emises and ,intended use and~cupa~cy,~ v of proposed construction: a. Exishng use and occuponcy .................. r. .......................................... * ..................... ~ ................................................ b. Intended use and occuponcy ............ .q~ ....................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 5-00 F 4. Estimated Cost ........... b/. ................................................ ee (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 aJteFations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ............ ~..Q ..... Rear .......... ~[...~. ........ Depth ....~..~..~. ........... Height ..~.~.f..~. ......... Number of Stories ..~.~ .......... 9, Size of lot: Front ...... (...~.,~ ......... Rear ............................ Depth .....~..g..~.R....n. 10. Date of Purchase ......... (?..~..~ .............................. Name~~of For~er Owner ~.....~.~:,, ,.,. ..... 11, Zone or use district in which premises are situated ....... ~...~: ..................................... ' ........... ' ....... '."' ..... 12. Does proposed constructisn vio~tG,any zoning law, ordinance ? r~ulDtion? ...... ~ ..................................... 13, Name of Owner of premises,~...~....Address ..... ~.~.~ .......... Phone NO Name of Architect..~,...~.~ .............. Address .....~.~.t;.;~ ............ Phone NO ..................... .................... Name o~ Contractor ................... Address ...... ~ ........... ~hone ~O. ~ PkOT DIAGRAM bmote clearly and distinctly oH buildin~s~ whether existin~ or proposed, end indicote aH set-b~ck d}mensions {rom property lines. Give street end block numbers or description occordino to deed, end show street names end ~ndicote whether interior or corner lot. STATE OF NEV~.,YO, q~K,/j~ ) S S COUNTY OF ..:~?..,,/~.¢r......) ' .......... iL~..._~...~..~.....x:3...~..~.-... ............. being duly sworn, depose,s and says that he is the applicant ,....._ (Name of~ individual sig~~) abOVe'named. He.is the ..................~~~~ ................ ~ ................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perfo,rm or ,have~performed the said work and to make and file this ap )licat on; that a statements contained i~this~pplication are true to the best of his knowledge and belief; and that the wor¢ will be performed in the man~th in the appliggtion file~ therewit~ Sworn to before me this ~. 4~.,,,~:~,~ ~ / '~ day of ~~ .~ 19 :~'~"':"¢'?c~? Po~ (Signature 'of apical) ....................... . . ............ ,. Nota~ Public, ~..~~ .......... /...:..~OU~ty ~ '