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Home My WebLink About254-zFORM NO. 4, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No Z. 177 ......... Date ............ .~...e.~..~.~.~...~..~.?...~...~. ................. ]9,~'..~.... THIS CERTIFIES that the budding located at .W./.~..~OPJ~. HQ~ .......................... Steer Map NoKe..~..~Y~/. 0..o..~. ................ Block No ........;~7~.X~. , Lot No ~, .~o.utho~...N,Y, conforms substanhally to the Apphcahon for Building Permit heretofore filed m this office dated'~ ...................... ~..~. P~. ......... 19..~., pursuant to which Building Perm,t No ..~...~'~ ............. , dated ................. ~.~.C..~ ....~..~. ........ 19.~'.~.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which th,s cerhficate ,s msued is ............ Th is cerhficate ,s issued to ...Jar0ea .~It.~]._l~Z~l ..... (4)~e~.) ............................................................. (owner, lessee or tenant) of the aforesaid budd,ng Budd,ng Inspector FOI~ N'O. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N.o (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 254 Z Permission is hereby granted to' Date ........ ........................... O'.r~renpoz,t'~ '"~tI';Y~ ............... to ........~,:~ ' 'a' ' ~ ' II~'I~l.'~l~ .................................................................................. at premises located at ...4i1~~. 'Kqll~lff'-~"~'~i~l,t~ ...... ~,tlf".~ "~ '~ '"']~b~ ......................... .............. ~ ......................................... ~u%:t~--o'~t'i ..... i~;T; .................................................................. pursuant to apphcotlon doted ................ 1~111~1~41 .......... ~ ................. 19.~[.., ond approved by the Building ?spector F~e ~o~.oo ............ Bu,ld,ng ,nspector %, TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ....................... ;;: .................................................................... (Building Inspector) Application No ..... ..~.... ?....~1 .......... APPLICATION FOR BUILDING PERMIT Date ......................... (.........-.: ...................... 1 ............ 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 o detailed description of layout of property must be drown on the diagram which is port 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 o 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 purpose whatever until o Certificate of Occupancy shotl have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 alterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable lows, ordinances and regulations. / (Signatu~-'~z - ' re of applicant, or name, if a. ,corporation) ., (Address of aj:~olicant) /t. State whether applicant is owner, lessee, agent, archi~ct, engineer, general contractor, electrician, plumber o~6ilder. Name of owne..f . ................... ~ ............................. /.~: ......... ; .......................................................................... If applicant is a corporate, ~Tgnature of duly authorized officer. (Nome and title of corporate officer) /x I. Location of land on whi?xproposed work will be done.. Map No: .~~~..~.. ,l~ot No: Street and Number ~.~...~..~ ~.....c~... ~...~ ....... ~~...F.. !L .................. ~ ..... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................ j,~ ..................... }. ............................................................................. b. ntenaea use ana occupancy ......................................................... .~ ................................................................... 3. Nature of work (check which applicable): New Building .................... dition .................... Alteration .................... Repair ............ :~,.....Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost...I....~.]~ ........................................ 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 ............................................................................................................................................ 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 .~..~ ................... Height ............................ Number of Stories ..~ ..... 9. Size of lot Front / ~ ~ Rear /..5' &'~ Depth~ ........................................ .............. .................. 10. Date of Purchase ..... ~._~.........'~.......~........./...~....~.....Nome,9f F~rmer Owner ~;:~..:L ................. ~...(-.u'~O 11. Zone or use district in which premises are situated ........... A ......... ~~ .................................. ' ' , ................................................. 12. Does proposed construct,on v,olate, ordinance or regulation? ... /V' () 13. Name of Owner of pre?sesc']l; .......... ........ Address ............................................ Phone NO ..................... Name of Architect....~....~.v....~...~..~ ..................Address ............................... ~ ........... Phone NO ..................... Name of Contractor.. ~.'.~...~c......~.....~.~..~..'~ ....... Address ~..6'...~..~.....(wPhone 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 NEV~ YQP~K,~ ~ ) S S COUNTY OF~ ...... ) -' /~/' (Name of Individual signing application) ageve named He s 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 ~st of his knowledge and belief; and that the work wi I be performed in the manner set fo~h i~;~l~c~tion filed thereTith. Sworn to before me this _ ~ da' of .... CT '