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Home My WebLink About276-zNO. ~ TOWN OF SOUTHOLD BUILDING DEPART/VtENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...Z..3,~.0 ........... Dote ................................ ~e....18 ........., 19,~c~... THIS CERTIFIES that the bufldmg Iocoted at..~t/~...T~.c.~...A~r.~. ..................................... Stree,t Mop No ~.,..S.:.~ ........ Block No....~ ........... Lot No. _~.9...~..~....~.~.¢..q~.o.~...e.~....~....Z.... ............... conforms substontially to the Applfcat~on for Building Permit heretofore filed in this office doted ............................ J~pz'~,....:]~ ......... , 19.~.~..., pursuant to which Building Permit No ...... ~.?...I...~.. doted .......................... ~...ZL~ ......... , 19~8...., 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 .............. ........................... .~.r.~,~...~..~.e...~.m.~...~.e..Z..Z.~ ........................................................................... This certificate is issued to .~fi..~..~'~..~.~. ........ ~.o.~.e.~.s.). ..................................................... (owner, lessee or tenant) of the aforesaid building Building Inspector N.o Per FOI~,~ NO. 2 TOWN OF SOUTHOLD BUILDINGi~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) g?6 Z Date ............... niss~on is hereby granted to' I ......................... It~f~Aweter Ave .............. ~ ............................... C~.t~tu~,~ ~ ..... 1~.~.., ....... ~m~.. ~,'~tt~t; ......................................................................................... ............ ~ ................................................................ ~"~e~o~e~ ~r~.~ ....................................... pursuon{ to oppJicat,on dated .................... ~J~L~' ]~j'"~(~[~J .... 19 .... , and approved by the Budding! Inspector Fee $. ~.t~01~ .......... FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ 19 ........ Permit No ............................... Application No....~.....7.....C~ ........... (Building Inspector) 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 drawn 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances an~eg~.,~ations. .........';¥ ;;';;;r;;;;;;;;i;;;;i ......... (Address of applicant) / / State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises....Z-~.A.~..4Z...../~,..~.~..zg.q.......~'dZ'),X?../.~.&. ~..*~.~,~.../~... ................................... 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: ......... '"?.i...~...~ ..................... Lot No:: .~..~..~¥...~.~.. Street and Number ....~.~.../~...~.Z~....../.i~...~..'.~. ....... /,~..?...~...~..~...~..~...~..../.~..:.~..i: ................................................ Municipality, 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ZT.;7.~,.Z ................................................................................................................ b. Intended use and occupancy cg/6~., t~./'L/.~...~. / 3. Nature of work (check which applicable): New Building....../,c~... ......... Addition ..... ..-z. ........... Alteration ........ '--z. ........... Repair ...... ~ ........... Removal ...... ~ .......... Demolition ....... ~ ......... Other Work (Describe) ..... W.::: ......... (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 .........¥...--Z. ............................................................................................................................. 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ...... ~.v:;::';; ............... 7. Dimensions of existing structures, if any: Front .......... ~;; ............. Rear ......... TT::: ............. Depth ...... ...'~..:z:. ............. Height ...... .~w.: ................. Number of Stories - Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ......~ii. .................... Height ......... :.::~ .............. Number of Stories ................................ Hei ht .....'.~..L ........... Number of Stories {../.,~. ........ ~2. L~oes proposeo cons ruc¥ on V o a e a y zen ng aw~ ora nance or regu a on ...... /.. ............................................ 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 propeFty lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. .~ ~; ........ being duly sworn, deposes and says tha~ he is the applicant ..... ~'~ ~i~ ~iO n ~'~" o~pilc,tion) _ {Controctor, o~ent, corporate officer, etc.) of soid owner or owners, ond is duly ~uthorized to per{otto or h,ye porformed the soid work ond to moke ~nd this opplicotlon~ that oll stotements cont~ined~i~..opplic~tion ~ro truo to the ~st of his knowledge ond belief; ond lhot the work will be performed in the ~~in the opplicotion filed thorowith. Sworn to before me this ~ ~ ~;~ el~ /'~ ~ ~ of ~ ~'~t~~ '~( ' nature ora cant) . ..... ~..~ ............ aay ........................................ ~v..~,..:.- o-e ~ (~ __ ap~'