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Home My WebLink About278-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~/~]].l~i..~ ~.t~en~,..~t, ............. Street Map No ....... ~ ......... Block No .............. ~X~-... , ~g(l~2~....f)~..~t-~ .... ~,.~.~. conforms substantially to the Apphcat,on for Building Permit heretofore filed in th~s office dated .................. A~.~I, ,~ .......... 19 ~., pursuant to which Building Permit No ...~.....~.~..~ ............ , dated ..............-~.]- .~?~ ......... 19.~.., was issued, and conforms to all of the requirements of the apphcable prowslons of the law The occupancy for which th~s certificate is ~ssued ~s ............ ......................................... .............................................................. Zh~s certificate ~s ~ssued to .... ~[~ ~e~e~l. ...... Co.~D.e~ ......................................................... (owner, lessee or tenant) of the aforesaid building FO~I~ NO. 2 TOWN OFSOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOL~, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N°. Per ~nission is hereby granted to ~e~ ~ell pursuon{ to apphcation dated .................... ..~..'~....~.~.......~. .................. 19..~..~.., and approved by the Bu~ldmg'~ Inspector Building Inspector LUCY B. GESELL BOX 112 ORIENT, LONG ISLAND Mr. Howard M. Terry Building Inspector Town of Southold Building Department Town Clerk's Office Southold, New York Dear Sir: On April twelfth you issued building Permit number 278 Z for alterations on my home in Orient. This work has now been completed and I assume that you will wish to look at it and issue a certificate of occupancy. Kindly do so at your convenience. whg:ls Yours very truly, 0 £ 0~.1 e:N'r ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~ ...... !?. 19..~.'....~ Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c .......;.. · ..:~r. · .~. · ~,~: ................................. ..,~, ~.~-"~'~'~"";~ ............. ................ ...... Application No....:~..?....~. ............ 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 odioining 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 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 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, end 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. / /] ............. .... (Address of applicant) State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ...................;.....m:. ......................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on whichl. I~ ~ ~/'m-- ,--~/pr°p°sed work.will be clone. Map No: .................................... L. ...... Lot No: .................... Street and Number ..... :...t~....~.,......~,..,..?...~..~.....~,,..~: ............ ~........~......~.: ......... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ............. ; ...... ; .......................................................................... 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 ~..~.?. ................................................................... (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 ......~...~.....~. ........... Depth ../..~.~.~.../.?...~./. ..... 10. Date of 11. Zone or ~ct ~n which p 12. Does proposed construct on v o ate any zon ng ow, ordnance or regular on? .......... ~ .................................. 13. Name of Owner of premises..~..~......Address ..... ~ ................... Phone NO ..................... Name of Architect ............................. ~.'. ......................... Address ............................................ Phone NO ..................... Nome 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 NEWq--¥,OJ~,.JK,~.,/6 ) ~; S " -) ....... ../......./..~...,~.....~._:...?..'.1.~.~......"...~. .................................. being duly sworn, deposes ~nd says that he is the epplieant pd~e of individl~al signing application) above nahned.--He is t he ..................................................... ......................... ......................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorize~Lto ~rform or have performed the said work and to make and file this application; that all statements contained~6~lt~l~plication are true to the best of his kqo~ledge end belief; and that the work will be performed in the~l~n~;/~.','[f;t,_/i~,n, the application ~jled ther,~,ith. Sworn to before me this ~reZeio o. ~ 6'ol~, oz' ,, ~.- / 1/'~ / // 1// I ....... ................. l - '