The URL can be used to link to this page

Home My WebLink About263-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the budd,ng located at .W./..~.......~.~..~..O..~.~. .......................... Street Map No ..... ~ ................. Block No .......... ~ ................. , ~.....~O.1,~.~f~..~(].~ ..... ~,Yo conforms substantially to the Apphcat,on for Building Permit heretofore filed m this office dated .................... ~.~,,~....3 ........ 19 ~'~.., pursuant to which Building Perm,t No .....~....~.6..~.. ............ , dated ................. ~-~...~.~.....~ ........... 19~. .... was ,ssued, and conforms to all of the requ,rements of the apphcable provisions of the law. The occupancy for which this certificate ~s ~ssued is ............ ....................................... ................................................................... Th~s certificate is ~ssued to .....~..~..~..~.]-.~.~...~.~.~...~..~' ............................................................................. (owner, lessee or tenant) of the aforesaid building FO~I~~ NO: 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT ,(THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) NO.. 263, z Per~nission is hereby granted to: of premi.,'es Iocated at . W~/.~ .... G~-~,~k--'!~Oe~ .......................................................................... ............................................................... · eutho~d ~ .... '~;¥; .......................................................... pursuant:to applicat,on dated ........................ AIFf'-J['t '3 ..................... 1~}...., and approved by the Budding nspector Fee $..~', Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No .............................. Application No....'?T......~....'~~. ............. Disapproved o/c ............................. .: ...................... r ........................... ; ............ · / ............... ~,Xi ....... :....f.....'.:..:......~ .................................. (Building Inspectlr) APPLICATION FOR BUILDING PERMIT 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 drown 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 purpose 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 alteratio~,-/or f9r removal or demolition, as herein d~scribed. The applicant agrees to comply with all applicable laws, ordinance' and' regulations. ........... · ~ .. ~,.,*~,. ~ .~ · ~. ~ .~-.[ .................... ~z.-.~.-6~...~....., ........... (Sight,re at appl~ant, or n~me, if a corporation) -, State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................................................... ~ ................ v- .................... i ............... i .................................................................. , 'rem,ses .................................................................. Name or owner at p ' . ......... :. ...................................... 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 ..... /~.,'~ ................ r. ........................ ; ........................................................................... Municipality 2. State existing use and occupancy Ofrgremises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... l~.&:.~."~ ...... :k ................................................................................. b. Intended use and Occupancy ............................... .t..{ ............................................................................................. 3. Nature of work (check which applicable): New Building .................... Addition ....... ./~.........Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated 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 ...................................................................................... 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 ...... I...? ................ Depth .......~........Z~.. ............ Height ............................ Number of Stories 9. Size of lot: Front ...... ]...~...~ ......... Rear ...... [..'..~....~. ............ Depth ....~.:~../...~..Z' ....... ]0. Date of Purchase .i f 5 '1 11. Zone or use dstrct n whch premses are stuated ';:. ..::: ................................................. 12. Does proposed construction violate any zon ng aw, ord nonce or ragu at on? ..... ...~.....:? ,D 13. N me of Owner o p em ses. ~.J...' ................................ 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~Z, YC~R]~, i J/ ) S S COEINTY OF ...x~,:.i:..j.~...~;L~..~,) ' ~(Name of individual signing application) 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 knowledg~ an~ belief; and that the work will be performed in the ~nner set f~i~ applicati~/f~ed therewith. ,~ / / Sworn to bef~re methis '~.~bli~.~_~ ..... ///~'~1~-7- ~::~ ~-~/, ........... M .......... uuy u ........... %'1 .......................... t~.~¢.'~;~ . 5~r,~ ~ ~..r~lg~Ture at applicanT3r I' ·