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Home My WebLink About497-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. Date .,........,.....f. ..... ............. (,._}~.-..-. ...... ............. THIS CERTIFIES that the building located at ............ G~L~D:~'o~..~O~C~..~..~J~.I;~, ..... Street Flee'ts ~ect:, Outchogue~ Map No....~.9.~ ............... Block No ......................... Lot No. 1L~...l~....~.t~..~, ..................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................... ~D.~f)~.,.~ ............. 19..~.., pursuant to which Building Permit No ...... .~..Z~,~ .......... doted ................ g.~C~,£~)g,~...'~ ............. , 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 .............. .................................................. ~.R~J~..D~LLI~G ....................................................................... This certificate is issued to ....~4~L~,f,4~I~.D'~:J;4~,...(4~G~.~ ........................................................... (owner, lessee or tenant) of the aforesaid building. FORM 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.° 497 Z Date ........... I~;~.~.~.......~,~ .................... 19.~..~... Permission is hereby granted to: Ct~s.ter.....O~:Low~.J~....A/.~..ll~.. .............................. ][..'~'.,, .......................................... to ....... .~u~;L~..a~.. ad d~t.tou..On., an.. mr. ts.t ~,~.. ~hmll,~u~: ................................................. at premises located at ....O~n~ooli..~,d..&../~.t.t~..~t ................................................................... ................................................ l~Ze~ts...l~aekt....On~t.....ilo. Z, ......................................... pursuant to application dated ............................... O~/6~D~ji~%~.....~. ....... 1~...., and approved by the Building Inspector Fee $....~'. ~0 ........... FORM NO. 4 TOYVb~ OF SOUTHOLD BU~t, DING DEPARTMENT TOWN CLERK'S GFFICE SOUTHOI. D, N. Y. CERTIFICATE OF OCCUPANCY No ......................... Date .......................................................... , 19 ........ THIS CERTIFIES that the building bcoted at .......... ;~'~Ot"~"~O~"~'"J~t~' ..... Stree,t Map No. "~9~ ............... Block No ......................... LOt hlO..]:~.~...~.~..~...~. ..................................... conforms substantially to the Application for Building Permit heretofore filed in this office doted ................... ~]~.~t~;[~4~2...;~ ............ , 19..~].., pursuant to which Building t~ermit No ...... ~..~ .......... dated ................ ~.~ ..~ .............. , 19..~.., was issued, and conforms to alt of the requirements of the applicable provisions of the law. The occupancy forwhich this certificate is issued is .............. .................................................. · 9~.~A~r~..:~t~ ~, ]~t~ ....................................................................... This certificate is issued to "'?~:~"~'~¢~'"~)i~'~'~'i~'~'~"~'~'~i ..................... of the aforesaid building. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. Application No ....... ..~..L.~...~.. ........ Approved ........................................ 19 ........ Permit No. Disapproved a/c ............................................... ..,.. .......................................... ............ ......... (Building Inspector) / APPLICATION FOR BUILDING PERMIT Date...~.~....2 ................................. 19 .~..~. ~. 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 Buildir~g 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with ali pppIicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) ............ .............................. (~ddress of applicant) ' State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises....~'J~ .... ! .......................................................................... If applicant is a corporate, sigr~ature of duly autl~orized officer. 1. Location of land on which proposed work will be done. Map No: .....'.~....~..~.....,~ ................. Lot No://.:..t..~.r../.~ Street and Number ..~...~.....~..~...~~../....~.:...~...~,.1~_.,,.,.~-,...-.¢",,-.~..-_~... .............. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... . .~..~ ............................................................................................................... b. Intended use and occupancy ....... Ck,~~.....~....~ .................................................... 3. Nature of work (check which applica'ble): New Building .................... Addition ../:% ............. Alteration .................... Repair .................... Removal .................... Demo!ifion ............... rC/4.Other Work (Describe) .................... ~ (to be paid on filing this application) 5. If dwelIMg, 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 ...i ......./. ................................................................................................ Dimensions of same structure with alterations 'or additions: Front ...... ~...~ ................. Rear ..... ..~......~..Zm'r ............... 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1]. Zone or use district in which premises are sit]uated ....... ~ '- '"./.~.~ ..................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ~- 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 desdription according to deed, and show street names and indicate whether interior or corner lot. STATE[ OF NEW, YJj;~',KI:~,/! ) S S ' ........................... : ............. bem~ duly sworn, deposes ,and says that he is the applicant (Name of individual signing opplicotior~ above named. He is the ................................................... ' .......................................................................................................... (Contractor, agent, corporate officer, etc.) of sam owner or owners, and is duly authorized to perform or hove performed the said work and to make and file this application; that oil statements contained in thisl application ore true to the best of his knowledge and belief; and that the work w I be performed in the manl~C~,sCtef~rt~.$cu_the application filed therewith.