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Home My WebLink About481-z TOW~ OF ~OUTHOLD I~UILDI~C.- DEPARTMEI~'T TOWI~ CLERK'S OFF~CE CERTIFICATE OF OCCUPAI~'CY TH~S CERTIFIES that the building located at .]~a~]L~i.~..~t;~,., ..~];~:J,.~;.~; ..... Street Map No ............. ~,~r... Block No ....... .~.~.~ .......... Lot No ..... ~9 ........................................................ confc~rms substantially to the Application for Building Pecmit heretofore filed in this office dated .................. .0..~.~0...~..e.~,..~ ......... 19~... pursuant to w.hich Building Permit No ........ ~....4.~ dated ................ .0..~.~..e.~._~ .......... 19.~.~..., wa~ 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 ......................... ]?l~:g'~:$Lq~g...C~l~ .~;P~I.~J,~..~X~IGI ........................................................ This certificate is issued to (owner, lessee or tenant) of the aforesaid building. FOR~! NO. 1 TOWN OF SOUTHOLD BUILDING DEPAP~¥MENT TOWN CLERE'$ OFFICE SOUTHOLD, N. Y, Examined ........................................ 19 ........ Approved ........................... ' ............. 19 ........ Permit No .............................. Disapproved o/c ..................... : .................................................................... (~uildinfl lnspector)~ Application No. L./~,.~ / APPLICATION FOR BUILDING PERMIT Dote ................................................................... 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 pert 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 port for any puFpose whatever until o Certificate 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, and ether 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 all applicable laws, ordinances and regulations. ...... ....... ........... ....... ......... (Address of applicant) ~t'-/W State whether applicant is owner, lessee, agent, a~hitect, engineer, general contractor, electrician, plumber or builder. N~me o~ owner o~ premises .......................................................... If applicant is a corporate, signature of duty authorized officer. (Name and title of corporate officer) h Location of land on whic~b, proposed work will be dpne. Map No: ......... :,,~.,. ............ : ................ Lot No: ..,.;..'T~,7;;; ...... Street and Number ................ } ................................. '~;i~:'i'l~'~ii't"~' ........................ " .............. 2. State existing use and occupancy of pr, emi~s,~and intended use and occupancy of proposed construction: a. Existing use and occupancy .................... ~..~:'.~~....~. ......................................................................... b. Intended use and occupancy ................................................................................................................................ ., _,,,.~: ~'4ew Building .................... Addition .., ./~C...,,,.....,.,Alteration .................... _~ ....................... Removal .................... Demolition ........ ~ ......... Other Work (Describe) .................... 4, Estimated Cost.,,.,~...Ot..O ............................................. 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, 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 ~ ........... /..~ ...... Depth ...~.,,.,O,. ................. 8. Dimensions of entire new construction: Front .......... / ................ Rear Height ............................ Number of Stories ..... ~ ...... 9. Size of lot: Front ............................ Rear ............................ Depth ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are s~tuoted ............................................................................ 12. Does proposed construction/',~ , ii-- ' '~/.v/plate any /Aning I,aw, ordinance,~,2, ,~' C~ e~/9~, ~~°r reoulation? ~1~.,?..~, ?...O. ................................... Nome 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 alt 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 NEW ~01~.~ j) / ) S S .................................... ~~ .................................. ' g duly sworn, deposes and says that he is the applicant (Nome of individual signing application)~]~ 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 and belief; and that the work will be erformed in the manner set forth in the application filed therewith _ Sworn to be~re me this ,/7/ ~o73, ~,~ 0~,~-~ /~/A ~ ~~ ~