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Home My WebLink About465-zFOEM NO. 4: TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .., .~..~:,.....~.~.c~¥~..~.g.[?..V.~%....~'.~'/.;L~Jw~ve, I~ast Mar~on Map No.?~.~ ................ Block No....~..?..?. ............ Lot No .................. .~:~.:~ ........................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ......... .............. .~.~..~.e.~....~..~ ........................ 19..~..8.. pursuant to which Building Permit No. dated ....~..e.~..t....e.~.e..~....~.~. .................... , 19....~.1~, was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is .......... This certificate is issued to ..... ~.O..~...~l~....~.~.:j,.~g'~.o....~¥~3.f~3~. ............................................................. (owner, lessee or tenant) of the aforesaid building. FORFI NO. ~ TOWN OF SOUTHOLD BUILDI~G DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, H. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 465 Z Date .............. ~ e.~ ~ e.~b~ :~..... ~.(~ ............ 19~8 .... Permission is hereby granted to: .~..~.~..... ~.~;~g.~ ........................................... ........ ...~...t,...,...~ .t,.....o.~.. ~..~ .................................... ..l~/8...J~et~.~...V~,ew...AYe~-...-~,~.t,..;t~.£on .... to ........ ~u~t.Z.&..ez~..a~:~.~e~..e~..e~..e~.et.~..~t:~.?:'~.i~ ................................................. at premises located at ...~/.~.....~.~.~..~:].~.~...~.~.,.....~.-a$~..~Eio~.~.....~:ff, ............................ pursuant to application dated ................... .~.ff.~..~.~'.~*.~.~......~6. ............. 19~8...., and approved by the Building Inspector Fee $. ~. ~..0..0. ............. TOWN OF SOUTHOLD BUILDmNG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~ ............... 19.....~.. Approved ..................... i~ ......... ].~......19...!.t...Permit No. ~.?'.]..~....~. ..... (Building Inspector) INSTRUCTIONS a. This application must be completely filled Jn 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 areos, and giving a detailed description of layout of property must be drawn on the diagram which is part of this Iocefion. c. The work cowered by this application may not be commenced before issuance of Building Permit. d. Upon approvo[ of this application, the Building Inspector will issue a Building Permit to the opp]icant. Such permit shall 'be k~ept 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 pukpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances ~ reg~ulations~//fl , (Signature of applicant, or name,Ci,f a corporation) .............................. · '2'- ........ "'"7 State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premlses.....v.......-w ............. - ...................................... ~ ........................................................................ i 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/N~' . ........................................... Lot No: .................... Street and Number..~.....~........~ ~.~.~....~....Z....~':~..c¢...~....(~...~: ........ ..,~..~.....~......~.? ~/ / Municipality 2. State existing use and occupancy of pr,emises a~tended ~se~and occupancy of proposed construction: a. Existing use and occupancy .......................... ~~..~. .............................................................. b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Budd ng .................... Add't on .................... Alteration .................... Repair ............. ~(~..,~qe~m~al .+~ ................. Demolition ............. e~tOther Work (Describe) .................... 4. Estimated Cost .............................................................. Fee .......................................................................................... (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, spec if_y_~a~t~re~, _,, and extent~°-fzzeaccl~type of use.....,~Z..~ ........... 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 ............................. ~N~nber of Stories ..... y" ~t~ ................... / ~ 8. Dimensions of entire new construction: Front....?.~,¢.~.,~.u~.. Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ............................ Rear ............................ Depth ............................ I0. Date of Purchase ........................................................ Nam~!~gf Fo~.ez~,~.O~.~ ................................. : ................ 11. Zone or use district in which premises are situated ...................................................... .~.~) ............................... ' 12. Does proposed construction~j~ol/¢~, eny zoning law, ordinance or regulation? .................................................... 13. Name of Owner of premises ........................................ Address ............................................ Phone NO..: .................. Name of Architect ............................. t .......................... Address ............................................ Phone NO. Name of Contractor .......................... .~ ........................ Address ............................................ Phone NO. PLOT DIAGRAM Locate clearly and distinctly oil 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. i¢ STATE! OF NEW Yf~RK,., J)' S S ,fT' ii'. . ."', . ..................................... ~.~',;;,.~..~.'[:/.Z.~'i.....u..';.,'....'...;~...'...,.'..:,~...being duly sworn, deposes and says that he is the applicant (Name of individual signing application) · ,, ~- ~,,~.~ ~ r',,-,--~-~ .. . .... above named. He ~s me ............................................. ,~.~r....~ .......................................................................................... (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 fortt.~ in the application filed therewith. Nota PuU c,