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Home My WebLink About320-zFORI~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD,. N. Y. CERTIFICATE OF OCCUPANCY · ugu~t 9 bio ... Z..%.~.. ..... Oote .................................................. 19 ........ THIS CERTIFIES that the building located at ~/S ~t~ ~t (Ne~ S~O~ ~reet Map No .......... ~ .............. Block No ........ conforms substantially to the Application for Building Permit heretofore filed in this office dated '. ......................... ~..~.~ ..............19~..., pursuant to which Budding Permit No ............................, dated .................. ~..~ .................. 19~...., was ~ssued, and conforms to all of the requirements of the applicable prows~ons of the law The occupancy for which this ce~ificate is ~ssued is ............ ~ATE ~LLI~ Th,s certificate is ~ssued to . ~t~S (owner, lessee or tenant) of the aforesaid building Building Inspector FO~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 320, Z Date .................. ' ......... ..1~...~. ................ 19 .~..... Permission is hereby granted to: at premises Ic~ated at .~i~..;..~t~.l~9...lll~..~.O].ll;t.....l~.~ ...................................... , ........ pursuant to appllcation doted ....................... ~lll~..~l~ .......................... 19..~.., and approved by the Building Inspector Fee $.~e~00 .............. FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No...?.....~ ........... ............................. (Building Inspector) APPLICATION FOR BUILDING PERMIT INSTRUCTIONS o. 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 o detailed description of layout of property must be drown on the diagram which is part of this location. c. The work covered by this application may not be ~ommenced 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 pren~ises Ov6iloble for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until o Certificate of Occupancy shall hove 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 and regulations. (S'gnat-ur~6f applicant, or name, if a corporation) ..... .................. ~' (Address of applicant~J State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electricon, plumber or builder. .Ct... .............................................................. Name of owner of premises ......... ..~... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No ................................... Block ........................... ~. ...... State existing use and occupancy of premieses and intended use and occupancy of proposed construction: a. Existing use and occupancy.....~...~..: ......................................... b. Intended ;3. Nature of work (check which applicable): New Building .................... Addition ~ .......... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ........ !...~ ................................ Fee (to be paid on filing this application) FEES: If dwelling, number of dwelling units ............................ Number of dwelling units on each floor ............................ If garage, number of cars ............. ~ ................................................................................................................. 6. If business, commericol or mixed occupancy, specify nature and extent of each type of use ................................ 7. Dimensions of existipg structures, if any: Front ....... ~..~. ............. Rear-...f.~.. .................... Depth .....~...~.. ............... Height ......... ..~....~...~. ........ Number of Stories ............... .~... ........................................................................................ Dimensions of same structure with alterations or additions: Front ....... ..~.~.../. ................ Rear .....~..~..! ......... i ......... Depth .......... '~-~......... ~ ........... Height ...~ ............... Number of Stories ...~/~c' ................ 8. Dimensions of entire new construction: Front ......... ~ ........... Rear .......~... .................. Depth ...2~"~' / Height ..-~mvx~lp. ........... Number of Stories . ~ ............ 9. Size of lot: Front ........ J..~...~. .......... Rear ...... h..~....~".. .......... Depth .....t..J~....~...~. ....... 10. Zone or use district in which premises are s tut ' 1 1. Does proposed constructia~ violate any zoning law, ordinance or regu at on? ....... ~ .................................... 12. Name of Owner of premisesl~..,~....~'...,..~...~/~ddress ....~..~.J~.....Phone NO/°-~.e./~..~...~..~..~ Name of Architect ...................................................... Address ............................................ Phone NO ..................... Name of Contractor..~.~....a~....~..~..Address .{~.~ ............... Phone NO/°-~,../~'..-.~...~...~. PLOT DIAGRAM Locote clearly and distinctly all buildings, whether existing or pro~sed, ond indicate olt set-bock dimensions from property lines. Give street ond block numJ~ers or description o~;cording].t_o c[eed, ond show street homes ond indicote whether ,ntenor or corner lot. - ~ ~,~.~, /~..~r~.~t , , , __ STATE OF NE~OP~, COUNTY OF~.~....) ..................... being duly sworn, deposes and soys thor he is the oppllcant (Name of individual signing application) L -.-~-- 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 and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this ....... Z?.ff~... day of ....~ ............. 19..~....... Notary Publi~~~unty Notary Public in the State of New York Resiumg in SuffoJk County Suffolk County Clark's No. 52-7614500 Commission Expires March 30, l~e6~' ~ O (Singature of applicant)