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Home My WebLink About316-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY TH~$ C£R-J'JF{~:$ that t~e bu~J~i~g ~ccted ct ............................................................ ~treet conforms substantially to the Apphcation for Building Permit heretofore filed ~n th~s office dated ................. ~.~ ...~..~... 19...~ pursuant to which Bui~d,ng Perm,t No ...~..~.Z..~...., Th~s certff~cote ~s ~ssued to .... ~w of the ~foresold bu~ld~n~ ~0~0. ~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN C~LERK'S OFFICE SOUTROLD, N. Y. BUILDING PERMIT (THIS PEP, MIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 316, Z Date ..................... Pert ~ssion is hereby granted to: ~n~..~se:L~ch~r~tt ...................................... .............. $?~,-.--~F/.-~. ~t, .............. .................. ~r~. -.--.;ea~ ..... ~t,..~, ............... to ....... t~ ~to~-.a~ e~t~..por~h..~n-.e~..e~dL-~'c~-d~e':Lt~ ........................... Ut prem~sis [oceted c~t ....,[a3-t,..lljlt..l~O~ ..... ]~ll~&lit--~'~MIl, lr .................................................... ............... ........................... g~e..~-~,ee..~g~a4 ............................................................................... ............... ! ........................................................ 2u~eho~ue.,.. N. ~ .............................................. pursuant ilo application dated ............................ ~...~/,~ .................. 19..~, and approved by the Budding Ipspector Fee $...5.0~l.....p~[d FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ....~........~... ~ ..~. ........ 19..~.....~.. "~ " ' t Approved .................. ...................... 19 ........ Permi No ............................... Disapproved o/c ..~,,~i;.~;~ ......... ........... ....... ............ (Building Inspector) APPLICATION FOR BUILDING PERMIT o,e ................. ........ INSTRUCTIONS a. This opplication 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, ond giving a detailed description of layout of property must be drawn on the diogrom which is part of this Iocotion. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon opprovol 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 Occuponcv sholl have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanoe of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other opplicoble Lows, Ordinances or P, egulotions, for the construction of buildings, additions or a Iterations, or for removal or demolition, os herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signata~e of applicant, or name, if a corporation) , . ......... ........ (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ,':' ~;.'..~Name of owner of premises ....... · ................................................................... · 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 N~o: .1...~...~.~.:~..~...~ Lot' No: .....A/....,...O. ....... Street and Number ....~...~.....~..~.......~'..,.~.....~.....0~.......~ .......... ~.~.~.,~...-. ....... .../~....'..~.".~. ........ MuniciPality 2. State existing use and occupancy of pr,emi~s 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 .................... Repair ............ ~,....Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estmoted Cost ..~...O..0.......~.~... .................................... 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 ............ . .~......(?. ..... D- ~, Rear ............................ Depth ..... ..)Z/....~.. .............. 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 ....... ..~......O.. .......... Rear .......... .?....~. .......... Depth ....~...~...~.......~.~ ..... 10. Date of Purchase ........................................................ Nome of Former Owaer ........................................................ l J. Zone or use district in which pram ses are stuated ~. ~ ~....~....~.. .......................... 13.12'Does proposed construction v~:)late/~./ ~any zoning law, or~nance......~...~..~-...fi~°r~regulati°n? .......... ~ Name of Owner of premises..V..~....~s ......... Phone NO ..................... Name of Architect ................................................... ~,,~ ./~ Address ............................................ Phone NO ..................... Name of .......... -~.~. fi/-...~..: ........Address ............................................ Phone NO ..................... Contractor 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~YOPJ(~/ ) S S COUNTY OF ..~..~I/......~ o o. ........... ~.~ .................. being duly sworn, deposes and says that he is-the app cant (Name ~ individual signing application)4,~ 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 knowledge ar~l belief; and that the work will be performed in the manner set.~orth in the application filed therewith. // // Sworn to before me this /f~,~ ..~//? ~0W~ %1 ..... ~, :~/,4./J~ ........... L.(.../5....~. day of ............. ./....v..~.....uz//////'~. ......... ., tq..~..j~"T.:~ ~u,ol~ c~, L,'"j~(SionatuJ~ of'aonlicant) ...... , - ,,/-- motary i-'UDIIC, ...... ~......~.~.....~I~W47,.X~4~.....County ° '"~h ~, 19 ~q