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Home My WebLink About204-zFORM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ;~ i~7 .......... Date .................. ]~.:~.~.~. ~ ................ 19~'~... THIS CERTIFIES that the bu,[dmg located at .S~,~ .... ~t~. ~,.O~L~ ........................... Street Map No ....................... Block No ........................ , ~_$t*~ ..... p.~Ot~.O,t. ..]~.~.,,. conforms substantially to the Apphcat~on for Building Permit heretofore filed ~n this office dated ............... .~T~'~,k'~......~ ....... 19 5~..., pursuant to which Bu,ldmg Permit No ....~...~.~. ............ , dated ............ ~r~L~U,~....~ ............19.~ .... Was ,ssued, and conforms to all of the requirements of the apphcable prowsions of the law The occupancy for which this certificate ,s ~ssued is ............ ........................................ /~-TE.... 'D~ELLI~ ................................................................. Th~s certificate ~s ~ssued to ..... ~!.b~e~r.t..~l~sh~ ......... ~w~er.) .................................................... (owner, lessee or tenant) of the aforesaid bu,ld~ng Bu,lding Inspector FORM ~IO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES Vv~liih~f~/l~,f>[lie(~F e~:'~P~[[~,~i~'d~~Fi,Ci~e~,~T~,~J~,~UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Perm~sston ~s hereby granted to Che~ter Om'lo,,sift. -..A/C....Albert ..F~r~k! .......... to .... E~ ~ ~di¢i~ ................................................................................... at premtses [ocated at ...~ ~ .~ ................................................. ....................................................... ~, ...,~,.~, ........................................................... pursuant to apphcation dated .............. ~~ ...~. .............. 19~. , and approved by the Building Inspector Budding Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. pp oved.....~ .............. ; ................ 19 ........ Permit No. -~ ~ C) ~' Disapproved a/c .................. ..~;Z...;,,,~, ~..;~., ~,,~" .......... ; ............... ,~" <~;;;~'__Sm ........ :'"i~'~ ...... (Building Inspector) Application No ....... ~ ...... ~ ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by ~vpewriter 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 proper~¥ must be drown on the diagram which is port of this location. c. The work coYered 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 pu?pose 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 Sotrthold, 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 I~rein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (STgnature of applicant, or name, if a corporation) ......... ~'~( "dress'; ............ o"J~ '"'"'~'applican;,"'~' ................................. State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name ofJowner o~j f premises.....~....../..~....~.~..~....~.......-'~_.~..~.....~...:...~., ................... 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 No ........ Lot No: .................... Street and Number ...2..~......~ ..~.....~.....~.;.'..& ...... .~....-~...~Z.~.. .......~.:T~...; ............................... 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 ....... (~-.4~.~....-~....~ ................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ...... ~ .......... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........... ~T.. ............................................... Fee ~' (to be paid on filing this application) §. 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 ......... .~....e. ................ Rear ........ ,~-.....~/. ............... Depth .......~..S.~. ................. Height ...... ~ .......... Number of Stories ............:::..'..~.. ........... 8. Dimensions of entire new construction: Front ....... ~..rJ .............. Rear ......... .~.eq<... .......... Depth ....'~...~....~.. ............. Height .......~...c(. .............. Number of Stories ....... ~ ................ /F... Rear ............................ Depth ............................~/~ ,,. 9. Size of lot: Front ...~.~,,,~:;~, 10. Date of Purchase ~. ..................................................... Name of Former Owner ........................................................ !1. Zone or use district in which premises are situated.....~?.~ ....... ..-z ....................................... 12. Does proposed construction violate any zoning law, ordinbfncerl or regulation? ...... ~.....~.. ................................. 13. Name of Owner of premises.~..~.....O~.~-~:.Address ..?.~...~....~...:.~...:......Phone NO Name of Architect ........................................................ Address ............................................ Phone NO ..................... Cont factor....~,,~..~r...~;..... Add ress Name of .(-,~...~t..l?....;..~..:Ph°ne 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 N~W YORK, /~ ) SS COUN ' (Name of individual signing applicotion) 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 statem~ents contained in this application are true to the best of his ~owledge and belief; and that the work will be perfSrmed in the manner set forth in the application filed~erewith. Sworn to before me this ~~