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Home My WebLink About304-zFOF. i~[ NO. 4 TOWN OF SOUTHOI. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .... ~- 20~ ..... Date .............O~ ~Ob~l?, ,.'1- ,~, ................ 19,~,.. THIS CERTIFIES that the building located at ...... 0~ ............................................. Street Map No...Eltge~'le...~e;t/~t,b~ Block No .......................... , Lot No 3g..& .,~3-t ..(]~t, eho&-aet N conforms substantially to the Apphcat~on for Building Permit heretofore flied in th~s office dated ......................... Ha]K....2, ....... 19.¢e~.., pursuant to which Building Permtt No ....Z....3~ ............ , doted ............... I~S,~.....2 ................ 19~.d,..., was ~ssued, and conforms to all of the requirements of the applicable provisions of the law The occupancy for which this certificate ~s ~ssued is ............ ............................. PRZ~.A~E.. DWELLIN~ ................................................................................. Th~s certificate is ~ssued to ..~r~y.. O,...K~.%l~el'. ....... (...o'~ner) ............................................ (owner, lessee or tenant) of the aforesa)d building F~ 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) N.° 3o , z Per~ission is hereby granted to: ......................... ~ute~, .... !I..~, ............... to .... 1~ ~-.m~-.e~.~e,!o~..*,e.-~. e~.m.t~l.-~.~..~ ................................................ at premises located at .,J~t,~..ijL.~ .&...~l ...... ~J~lg~e-JJe~Ll~.t,~. ............................................ ................ i .............................................. ¢~.t, otm~ ..... lf.,.!~, ........................................................ pursuant tb application dated ............................ __1~_ y:.....,~ ...................... 19.~J.., and approved by the Buddmg In., spector Fee $~, g~) .............. ........ l Buifding Inspector 'F FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. V. Examined ....... ..~.~.(.~.......~....... 19.~ ~.~i~' Appraved ........................................ ]9 ........ Permit No ............................. Disapproved a/c ........~ .......... ~ ....... J;""'t ........... "'~' .............. ~ ............ ~ ...... ~ i~. :..,. 5~ ...... .C.~x':l (Buildin~ Inspector) ~ APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su~omitted 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 drawn on the diagram which is part of this location. c. The work coYered bv 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 ~'he 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 Certificafe 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 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 whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of p ............................. ~t ........................... ,~....~... ...................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of and on which proposed work w be done Map No' ..~....~ /~L~ Lot No' ~ ~ ~ 4L ..... : .................... ...... ..................... Street and Number .....k.~~.~ ................. ..~.....¥..~.. ............... ~.~.~...: ....... : ............. ? .~..~. ................... Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and occupancy .....................~.': ......... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration ...,...1:~.. ........ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost....~..~..~ ................................................ Fee ..~ ...................................................................................... (to be paid on filing this application) ,5. If dwelling, number of dwelling umts ......... .% ......... ........... Numbe 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 ........ ..r~...~ ............. Depth ......¥~....~.. ............... Height ............................ Number of Stories .....C7~...~?. ................................................................................................ Dimensions of some structure with alterations or additions: Front .......... ...~..'.~ ....... Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~.'.~. ............. Rear .......... ../..~. ........... Depth .....~ .................. Height .....~.;...(9.~. ........... Number of Stories ..... ~ ................. ~ .......... ~.'.. ~ .......... Depth....¥. ~..../.~ ./.'.. 9. Size of lot: Front .......... ~...~ ........Rear 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated /~.. 12. Does proposed construction,J,./j'vi,°!ate any ~ning law, ordinance or regulation? ....... ~.~ .................................. 13. Name of Owner of premises~/.'..~....~c.~.~....~L~.~...Address ............................................ Phone NO ..................... Name of Architect ............................ .:! ......................... Address ............................................ Phone NO ..................... Name of Contractor ......................... ~ ......................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly end 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'~ YOJ~(, .'./, ) S S COUNTY OF ..;;~..~..~......) ' c- ..--~ ~/'~' '--~ ' ein ~ ' ~C ~ b sworn, .................................... · ~ ............... ( ............... . ~. . g duly deposes ond seys thor he is the ~pplic~nt (Neme of n~ividuel signing opphc~hon) obove homed. He s the ...................................................... ~~ .................................... : ........................................ (Controctor, egent, corporete off cer, etc.) of sold owner or owners, ond is duly outhorized to per~orm or hove performed the seid work ond to m~ke ~nd file this applicet on; thet ell stotements contained ~i~lic~tion ~re true to~e ~st of his knowledge end belief; and that the work will be performed in the man~~the applicatio~ filed therewith. ,~ ~ n J Sworn to before me this ~ ~~ ~ r,., ~,~ ~ ~~'~ ....................... ...... ...... ,.