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Home My WebLink About205-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY ']'HIS CERTIFIES that the building located at ....~...1~...~...~.~.~..~.....]~... .............................. Street Map No..~...~.?~....~.~..~...~...t'~...t?l~bck No .............. ~ ................ , Lot No. ~Z,.....,l~l~t,t,~t~l~t. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................... ~...6.t..].c~.~..19 ........ , pursuant to which Building Permit No ....... ~..~0.~' ......... , dated .................... .~....~...'......~.~. ................. 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 ............ ................................................. ~],Y. &~ ~... ~,~tf~. ........................................................................ This certificate is issued to .~.~.~...~..~0,~.~,~.. D~-~..~ .......... (. .. ~I~,~Z'.~.~ ................................ (owner, lessee or tenant) of the aforesaid building. Building Inspector FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES ,I~~~B*,~t~*~q[--~h~-K)fN~J, UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Permission *s hereby granted to ~ari~. ~..r:.d.....~...d. re.~.... D. ~.H~.vc9 ................ .... ~..02 ~...69.~h..~t~ ................. .... S.e.w. ~.o.?..~...Z.Z.~ ...... lf,.~,. ................. to .~.~:l~.....a~.. &.d..d..i...t..igT$....t.9' .e...~$.t.$.Tt~..dWf~lllnt[ ................................................. pursuant to application dated ..... .j'.f~....l~J~y 6 .................. 19..~..8..., and approved by the Budding Inspector Budding Inspector / NO, I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ......... ^pproved.: ........... :.: ................... ,9 ........ Perm,t No....~..~.: ....... Application No ...... ...~.,..0....?.. .......... Disapproved a/c .......... ::7~"..:. ..................... : ............................ ;:: .............. · ~ :. :~ ,. ~ . .'., APPLICATION FOR BUIL~ING. PEJ~ ~ ~.~.~. · ~X Date.../..l.....~...~_. .............................. /. ' "~' ~ '~" ~' ','~V x'~'~'~' "~, . ~.. I,/,.. 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 a~lication may not be commenced before issuance of Building Permit. d, U~ approval of this application, the Building Inspirer will issue a Building Permit to the applicant. Such per~,t ~ be ~t on' ~e p~va, ab e for respect,on throughout the progress of the work. e. No building shah be oc~pied or used in whole or in part Jar any p~Fpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. ~i j~ '. , ~ ~ th~ issuanoe of a BUilding Permit pursuant to the APPLICATION IS HEREBY MADE to th~ Building Departm~t Tar Building Zone Ordinance of the Town of Southold, Suffolk Count, New York, and other applicable Laws, Ordinances or Regulations for the constructiop~of ~uildings additions or,ali~atjons or for removal or demolition as herein described. The applicant agrees to compl~,th~ll ap~,cable laws, ~in~ and re~lat,~. ~.. J J . (Address of a~lic~ / ' Store whether opplicont is ownor, losses, ~ont, orchit~ct, ~n~ine~r, ~enor~l contractor, olectricion, plum~r or builder. ................. ............ ....... ....................................................................... .......... ...................................................................... ~J{ applicant is a corporate, signature of dul~ author~zed_.off~f~r.. .......................................................................................... ~.).,..t ~ ~ .,~ ~ , , (Name and title of corporate officer) 1.L~ation of land on which proposed wo~k will be d~ne. Map No: ...... ~...~...., ................. Lot No: .......... Street *nd Number ......... ~ ......................... Municipoli~ 2. State existing use and occu~ncy of ~r,emises and i ntended~use a~ancy of proposed construction: a. Existing use and occupancy .....- ''~.~~.....~ ................~:......' ................................................... 10. 11. 12. 13. 3. Nature of work (check which applicable): New Building .................... dition ....... ~....Alteration .................... Repair ................. ...~oval .................... Demolition .............. ~.~j~Other Work (Describe) .................... 4. Estimated Cost ............ .~......~....4. ................................... Fee ............... ~ .................................................................. ~~.9 (,o 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 u~ .............................. 7. Dimensions of exi~ing structures, if any: Front.....~.~ .......... ~ar .......~ ............ Depth ..... Z.~ .............. . ............. 8. Dimensions of eg~re/new construction: trent ............................ Rear ...... ~.~.~. ..........Depth . ~ / Height ~ Number of Stories ~ ~ ..................... ....................... / / ....... ............ Size of lot: Front ....~..~... Rear ...~....~... Depth .................... ~... ~ , . Date of Purchase ...... ~...~,....~.~.~Z ...... Name of Former Ow~r ..~~...~ ........ Zone or use district ~n which premises are situated ...... ~.....~ ................................. Does proposed construction violate pny,~oning law,, ordinance or regulatioo? ...... ~...,~q...~ .................................. Name of Owner of prem,ses~.~.~.l~ld~~..~...~:.~.f~....~ne 7 Name 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 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 NEW YORK, ) S S. COUNTY OF ............................ ) ....~... .. ~ ............. being duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the ............................................................................................................................................................ (Contractor, agent, cqrporate 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 ir~this application are true to the best of his knowledge and belief; and that the ~,ork will be perf. e~ned in the man_n~-----~rt h in the application filed therewith. Sworn to~e !~.. ...... /....~-..~ .......... .~.. '~;;;; '~'~,, ~ ....... Notary PuNi~.~~/? .......