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Home My WebLink About462-zFORM NO. 4 TOWN OF SOUTHOLD BUILDIhiG DEPARTMEhiT TOWN CLERK'S OFFICE SOUTHOI. D, hi. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at..~..t,,...l~.~.W/..~....~.:k$....~.~..e.....~..'.9...l~...~6t~,Ponia Map No ......................... Block No ......................... Lot No ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... .~.~.~.Q~.~...~, 19....~, ~rsuant to which Building Permit No....~...~.~ ............. dated .................. ~.e~.~...~ ...... , 19.~.., was issued, and conforms to aH of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .............. .............................................. ................................................. This certificate is issued to ~.~.~..~$~...~ ....................................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector HOWARD ~, TERR~ FOI~M 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.° 462 z Date ................ k~ll]l~"'"'~ .......... 19.~.. Permission is hereby granted to: .......... Pel~a~e.. tlosd~..t//~., tli..L-t...I, ase ..... ....................... peeeaie r ....~1,1'~ ........................ to ..... ~..v~r.e~ml~ial-.~o.-~,e~taee .exist, ia~.-svaaet-.~o~a~e ....................... at premises located at ...pl~e...~l~.i.....M/~.....j~:[;~..1...~O .................................................... ................................................ Feeon~.t.....tl~~ ............................................................................... pursuant to application dated ............[[~IIIIII]IB~'"'~ ..................... 19~...., and approved by the Building Inspector Fee $.1 ~1,~0 .......... TOWN OF SOUTHOLD BUILDIIqG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLDI, N. Y. xam~nea ...........~z...~.r .............................. Approved ........................................ 19 ........ Permit No ....................... Disapproved a/c ...7 ..... 70 .............~7~ ............. ~:~ ............ ~ ......... ................. ........................ (Building Inspector) Application No......~..~..~..~. ......... APPLICATION FOR BUILDING PERMIT Date ................... .~_..u ................................................ 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, 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 issu.ance of Building Permit. d. Upon approval of this application, the Building Inspector will issue o 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 cJ Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc.e of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, ond other applicable Lows, 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, ordin~. ,/~/,/~ ,, ...... (Address of applicant) // State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premlses.......~../...~/..~...~./..~. ........ ...~......~.../....'~'..~. ..................................................................................... If applicant is a corporate, signature of duly authorized officer. ....... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number ....................................................................................................................................................... Municipality State existing use and occupancy,,,,~_. ' ~ -~-.- l°f pr,emise, s and intended use and occupancy of proposed construction: a. Existing use and occupancy ~ ~ ...... · ~...-..... .................................................................................... b. Intended use and occupancy.~..~. ................................................................................... 3. Nature of work (check whic~ applic~ole):-- ~;~'~ ~ -New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... Cost 4. I:stimated .... ~ ...................................................... t-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 cors...~.~.~ ................................................................. - -" ature and exf~nt f f 6. If business, commercial or mixed occupancy, specify, na ure and ex ant o each type o use .............................. 7. Dimensions of existing structures, if any: Front...~....~. .................. Rear......~.../. ................. Depth .~.....~.. .................. I Height ..../....~... .................. Number of Stories .... ~ ........................................................................................... Dimensions of some structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front...~....~.. .................. Rear ...~.~... ................. Depth .~'.~..~... .................. Height ..... /. ..................... Number of Stories ...~ ............ 9. Size of lot: Front ....LI~...~.. ............... Rear ...~...~.. ................... Depth ..~.~...~...:..~....O-.~.,~ 10. Date of Purchase ....O~',/(~....~,/..~...~.. ................................ Name of Former Owne~..~...~.~ 11. Zone or use district in which premises are situated......'~....':....~ ........................................... 12. Does proposed construction~.v.~late any zonin~g Iow, ordinance or regulatior>~...~¢~ 13. Name of Owner of premls~..~.~ddress ./..~....~....~..~....~...~hone 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. .4,' STATE OF NEW YORK, m/, ) c S ' COUNTY OF ~,..L~.....) -~ · . ............................. ~ ........ belng duly sworn, deposes .~nd soys that he is the applicant (Nome o ' d'v'duo 'g ' g pp ' ) above named. 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 all statements contained in this application are true to the best of his knowledge end belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me th~s ............ ~..'~.... day of ...~~ ............ ]9..~t,~.,'t:i:~',,:'c~?i~;"""" -- ~',nt. (Signature of applicant) -I