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Home My WebLink About243-zFORM NO. 4~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Mop No ............................... B.ock No ....... ~ .................... , ,o*-~. .... conforms substantially to the Apphcabon for Building Permit heretofore filed ~n this office dated ............. .~..../.!~....~....x~..../...~....19 S~, pursuant to which Building Perm,t No ..... ...~........~i....¥.....~.., dated ........ ~ .¢:~....~.....f...S ....... 19 .?....~, was ,ssued. and conforms to all of ,he requ,rement, of the applicable provisions of the law The occupancy for which this certificate ~s ~ssued is ............ Th,s cerbf,cate is ,ssued to .~ ...... ...~..~.'~ ........... ~...~..).. ¢owner, lessee or tenant) of the aforesaid bu,ld~ng FO~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT~OLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 243 Z Date ........................ ll4L._~.~.....}.5. ........ 195~... Perrhission is hereby granted to: · A~_ Lt~c,_ a~r ... · '~t:I:OT~F ah .................................. ............ ll~-'8'tz'ee~ ......................... ..................... t~au~.i...~l; ~,; .................... to ..... ~1~ ~ld 'an~"'~d~.'tJLun"'t~'"~"~X~L'~l~t~'g"~/II~ ...................................... at prem,ses located at "ll/8'""llllLt~"l[lJl~ll~tt~ .................. I[ '~]~"d~lit~jctt"]l ...................... ................................................... ~a~.~td i' ..... N;'Z;' ....................................................... pursuant' to applicat,on dated .............. ~t~'"]:~' 't9~I~ ............ 19 ........ , and approved by the Budding Inspector Fee $'~'i'00""]1~f~ I ' ~' u, ding I nspec;~' .......... I ....... l~O~,a'~[ NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. · ~.~1~ ~.~- I ~ ~',~/ Examined .......... /..~.t ...................... 19 ........ Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ~-'/ ........... 7.' ........................... ; ......... ;..7~>'~'~7::~': ........ ............... .......... (Bui~din~ Inspector) Application No ............................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su/amitted 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 co~ered 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 t~hroughout the progress of the work. e. No building shall be occupied or used in whole or in part for any ~)u~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 o 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~plicant, or name, if a corporation) .......... ........ -- (Address of applicant) State whether applicant ~,~wner, le,~_ssee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a co,orate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map J',lo: ............. ~.~ ........................... Lot NO: ......... .-~..~ ...... Street and Number ....-.~...~..~,~ ........... ~:...: ............. :.~ .......................... :; ................ ;..Z: ................................ Municipality 2. State existing use and occupancy of preg~jses and intended use and occupancy of proposed construction: a Ex~stmg use and occupancy .................................................... .-3DZ....{[ ....................................................................... tt b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition ........l~............Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... cost - .[..o.. ....... 4. Estimated ............................................................ tee ................................................................ (to be paid on filing this application) §. If dwelling, number of dwelling un.ts ................................ 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 ..<.~....6...~.-~.. ........... 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 ..../...~ ........... Height ............................ Number of Stories ...... ~ ....... 0 9. Size of lot: Front ....... ./..~..~.......'~..... Rear Depth 10. Date of Purchase ..... /...~....-~...i~ ............................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............. ~ ........................................ 12. Does proposed construct on voate gny zonng aw, ordnance or regutaton? ....... .~...~...~.. ............ 13. Name of Owner of premises....~.....~.~..~.~.-.'Address ..... ............... Phone NO ..................... 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 NE~J Y_Z~RI~. ) S S COUNTY OF ~ ............... ) ' ..................... indi~.d6al signing application) being(Name of duly sworn, deposes and says that he is the applicant 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 statements contained in this application are true to the best of his knowledge ~d belief; and that the work will be performed in the manner s~r~/}~ ~he applicati~.!ile~rewith. ~/ , ~ , Sworn to before me this _ ~e~/u~li~, ~ ?~o~ /~/H /~l~xl4 ~, '~ ~ ~A4/~ ~ ~1~ .............. ~~...: .......... County ' ~c.~ 2g,