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Home My WebLink About555-zFORM NO, 4 TOWN OF SOUTHOLD BUBLDIHG DEPARTMENT TOWN CLERK'S SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located ot.¢,/..~,,.~.g,.~,.~,~,~..A~.,l~.t.~..,~.~.,.~.~,.~.~.~..~.,. Street Map No ...........'.7..'.. ........ Block No ......... .'....'r~.. ......... Lot No ....... ~..~..'. ....................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................... ~..r.~..~...~...~,~...~. .............. 1%~..,, pursuant to which Building Detroit No .......... ~.~. ........ dated ............... nT..8.~,~.~'.,,,~.~ ............... , 19.~[~1..., was issued, and conforms to oil of the requirements of the applicable provisions of the Jaw. The occupancy for which this certificate is issued is .............. ......................... ............................. ................................... This certificate is issued to ....~.~.~....~..8:.~.O.,.~.:L..O.~..~.~~. ..................................................................... (owner, lessee or tenanO of the aforesaid building. Buildin~ Inspector FOR~I NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. BUILDING PERMIT THIS ~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 555 z Dote .............. ~t~Z]tTg~r ~ .......................... 19.~9.. Permission is hereby granted to: W~. Beeb~ ,.~;,/0 a~,, ",,~:~0~ .......................... .............. ~u~o~zte'~' "" 'N'; ~Z'; ........................... to ......... '~U'i:~d'"a~" ~d,~'i t-'t'o~"ecrr'~n'"~!~t l~g'"d~.~e~'~:~g ................................................ at premises located at ...... .s, ...... ~ .~ . .~ .... f ............. ~/~ ~?d~: ~x,~ ............................................ ....................................................... ~tt%~ho~V"'t~ ;'~'~' ................................................................... pursuant to application dated ..................... ~l~'~y'""~ ................... 19.~.., and approved by the Building Inspector Fee $...5.,.00 ........... Estimated Cost $ ........................ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. Examined.....~..O.~ ....... Approved ....... r.......~. ....... 19..~..(.Permit No ............................... Disapproved a/c ..................................................................................... Application No ............................. APPLICATION FOR BUILDING PERMIT Date ......... ....... ............... INSTRUCTIONS a. This application must be campier, ely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of Iot and of buildings on premises, relationship to adjoining premises or punic 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 in part for any puFpose 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 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 all applicable laws, ordinances and regulations. ....... .................................. (Signature of applicant, or name, if a corporation) State whether applicant. As owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, ~i~iature of duly authorized of{icer. (Name and title of corporate officer) 1. Location of land on which proposed work v~ill be don,e.. Map No: .............. ~ ......................... Lot No: '7.; ................. Street and Number ...~.-...~....~:....1,¢/.¥.,':..'z~-.....';...,,..~.,..~......~...~. ........ .'Tr::..:.~..,,~ ......... ~.....¥....~.. ...... ~.~,. .................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing useandoccupancy ............. ~Z~..~] .......................................................................................... b. Intended use and occupancy ........................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition ....... ;~ ........ ~bOther Work (Describe) .................... 4. I--stimated 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 ...................... :.....T'.. ............................................................................................................. 6. If business, commercial or mixed occupancy, specify Mature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front ............ 1'....~.. ......... Rear ......... L....~.. ........... Depth ..... !.f .................... Height ............................ Number of Stories ..~..q:.....~ ....................................................................................... Dimensions of same structure with alterations or additions: Front ....~....'~. .................... Rear .~..~.. ........................ Depth ......c~..¢'~...( ............ Height .............................. Number of Stories ...~ ............. 8. Dimensions of entire new construction:, Front ......... ~.~......~. ......... Rear ...... ~..'.~....'~.....~ ......... Depth ..../. ....................... Height ............................ Number of Stories ..... ~ ....... ~ .... ..H,..o...~.. .............. Depth ...L~...~...~ .......... 9. Size of lot: Front ..... ..~L.9 ................. Rear 10. Date of Purchase ....~....!.~...~...~ ......................... Nam,e, of,. For~_~twner ........................................................ 1],. Zone or use dJs,trict in which premises are situated ........ ~ ................................................................................... -- t2. Does proposed construction vi~ate any zoning law, ordinqnce or Leg~llation? .......... ../~.....0. .................................. 13. Name of Owner of premises.~......~...~Address ..... ~ ............... Phone NO ..................... Nome of Architect ........................................................ Address ........................................... Phone NO ..................... Name of ~ontractor....~..~ ............ 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. i~T~TE OF NE Y ~1 ) S S COUNTY OF ~~) (Nome of individual signing ~pplicotion) ~JL above named. He is the .................................... ~,.,~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 m'anner set forth in the application filed therewith. Sworn to before me this (~ ' ' .~... day of ~.....;:::.:...~ 1 ~'.~... (Signature of applicant) -- C t Notary Public, ............................................................ oun y