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Home My WebLink About532-zFORM NO. 4 TOWH OF SOUTHOLD BUILDING DEPARTMENT TOW'Iq CLERK'S OFF~CE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at.~.~,~..~.g.~,..~l~lil~,~....~..~.~.~...h..o..~.~...e..,....~..~...~..~ Street Map No. *** Block No. ' *** Lot ~' *** conforms substantially to the Application for Building Permit heretofore filed in this office dated ...................... ~X~A~..g! ....... , ~9.~.., p,~,o,~ to ~hich B,,di~g ~.~it No...,~.~. ............... dated ..' ................ ~q~.~..~ ......... , 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 .............. PR~A~ D~ELLING This certificate is issued to ...... .~.~..~. ...................................................... : ....................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FORUM NO. ~ 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) N9 532 Z Permission is hereby granted to: 01~e stez~ OC ~..o?.45~g..... ?..~.~ ........ ~.o..~ .e. ~..h...... ~9..~.~..n...a. .......... ............ ~.¢. g..h.9.~.~..9. ,......~.:.~.: .............................. to ...}-?,~ .Jr.~ ~...ti ~.~:(. · .(:]~/. ~.].:-]'. ~: .~. g. .............................................................................................................. at premises located at ....~/.~.....~g.~(~.~...~a~/~e ................................................................................... ............................................... .c..9...'F..q ?-...°.~.e..,..... ~{: .~ ~ ........................................................................... pursuant to application dated .................. fl..O.~.~..~.....~.~'~ ................. 19.~...~..., and approved by the Building Inspector Building Inspector I~ORM NO. I / Examined ......~~...~.....c/... 19....~....~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... Application No.......~.....~....~ ...... Disapproved o/c ................................................................. (Budding Inspector) APPLICATION FOR BUILDING PERMIT Date........~.-;..Q4/.,-:....,~.../.. ............................. 19.~.~.. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in dulslicate 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 Jn part 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 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 all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) .......... ....... : .......... .............. (A~dress of a~licant) -- State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises ........ t~/~.,~?~* ................................................................................... If applicant is a corporate, si~gr3dture of duly authorized officer. (Name and title of corporate officer) Street and Number ...~..~..,~.c~¥~'~.~,...~~w.,....'~....,~.~...~...:,~..~. ................................ rd 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~...,.~....c2.~..~;...~.~....~.~,~...~:.~.'..'"'~";.~ ...................................... 3. Nature of work (check which applicable): New Building.....,4~. .......... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ................... ._O~el~Work (Describe) .................... (~o be paid or,filing this application) 5. If dwelling, number of dwelling units ................................ Number of dwelling uni¥ 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 ................................ 8. Dimensions of entire new construction: Front ....... ,~:~...~ ............. Rear ........ ~....(~ ............ Depth ....-~.....~.. ................ Zone or use d~stnct 12. Does proposed constructionviolate any zoning law, ordinance or regulation? ...... .K...(c~........-~... ............................ Name of Archifect .......;.b..~..g. ......... .;;z ........................ Address ...;.~. ............... i ...................... 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. STATE OF NEWc-YOP~K~, ~ _) S S ...~......~-..4~'z~.4/~ ....................................... be ng duly sworn, deposes and says that he is the applicant (Name of individual signing application) (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 _forthEl.l~l~h~01JJ~llcation filed therewith. -- . ~L' J~ PubliC, State of New Y01J Sworn to Detore me Tnls __ ~_ ~ Residing in Suffolk County