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Home My WebLink About273-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the build,ng located at.~/.q .Y~tt [~:1.....(.~..2.%~) ............... Street Map No . Z~.7~..~ ......... Block No ........ ~ ..... , ~ ]~l. tt.;[.f~l].~e ..... J[~.~, conforms substant,ally to the Apphcation for Building Perm,t heretofore f,led ,n th,s office dated .................... ~.~... ~.0. ......... 19.~'~.., pursuant to which Building Permit No ..~..~.-.~ .............. , dated ............... ~$.~,..].~1, ............ 19~..~. .... was issued, and conforms to all of the requirements of the opphcable Drovislons of the [aw The occupancy for wh,ch th~s certificote is ~ssued is ............ ............................. PR;~-~A,~ E...I)~/ELL;~ ........................................................................ This certificate is issued to ..,~l~:~¢:b'l~t..C.,..~tq~t ........... (..~e~'.) ............................................... (owner, lessee or tenant) of the aforesaid bu,ld,ng Budding Inspector TOWN OF)O~THOLD BUILDING ~EPARTMENT TOWN CLERK'S OFFICE SOUT, t , N. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N9 273' Z Date ...........~IJ~;L....~J. .................... IC~,8 .... Peru ~ssJon is he~reby granted to: ............................. Jlat~.~Lf. uek~ ..... ll,..Y, ......... to ....... ~_S_ ~d.. ~e'~...d~eil_t. _~ ................................................................................................... at premis ,s [ocated at .... S//~J....JJ~b~lJ:l..~ ............ (~..J~llkli.. ~J~"~l...~J .................................. .............. ~ ...................................... Ig~.~,~L.~*; .................................................................................... pursuant~o opplicatmn dated ............ ~1~'.~....~[,0 ........................ 19~..., and approved by the Budding Inspector Fee ......................... iSEi~i;~"i;~;~';~i[;; ............... l ..... FO~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. E×om~ned ......... ~.~....../..( ....... ,, , Approved ........................................ lO ........ Perm t No ............................... Diso rove' a' ~7 w pp a /c ................... .;,...,, ................. .../. ................ ~.~ ..................... // ............ ...... ( ' 'o p ) I Application No ............................. APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. This application must be completelv filled in bV 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 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 puFpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanae 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) (Address of applicant) ~J State wheth.er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. · C~ Name of owner of premlses.~ ............ ~..~.~..~.-,¢w~.. ................................................................................. If applicant is o 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 ~.~.1~...-~-=~.~.~..,,..-.~..:..?Je.: ........................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy.....~~....~ ................................................................... 3. Nature of work (check which applicable): New Building.....~.....Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost.......'~.../..~.~.~....o....~. ................................ Fee ../...~....e...~. ............................................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... .q..,: .............. 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 alte~tions 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 ..... /....~...0. ............. Rear ....J..0....o. .............. Depth /...~..O..~...~.~..../..~'..~1- 10. Date of Purchase ......(~r,~..~.~..(.~.~..~. ............... Name of Former Owner ~..~.~ ............ 11. Zone or use dstrct n whch premses are stuated...'~.. ........................... ~.. /'~ ~ .................. 12. Does proposed construction ~y,~o ate any zon ng aw, ordnance or regular on? ...~ ................ I)-E- , ~ ~ .,~. ' .......... Phone ' "~ ................... 13. Nome of Owner of premises~.....;~Address¢..........~.~...,~ N O.d ~...~...;~...-~....~/. Name of Architect....~...: .............................. Address ............................................ Phone NO ..................... Name of Contractor.~....~....~ ...... Address~l..~;.j~}:....Phone NO.I/'/./:C.J..: ........ 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, ) COUNTY OF ..~ ....... ) S S. ...................... ...... .......... du,ysworn, (Name of individual signing application) 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 t~l~erf,~rm or have performed the said work and to make and file this application; that all statements contained, in t,J~'.~cation are true to the best of his knowledge and belief; and that the work will be performed in the ma~e~.~,,~,..~,~h,, in the application filed therewith. Sworn to before me this "%%~o. /o c~,~o~' ~ ~ ~ ~ ~ _ _ ........................ day of ............. ~ .................... ~ 19.?.~ ~,. (S.gnature of oppl,cant)