The URL can be used to link to this page

Home My WebLink About321-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ....Z.....I~.6 . . Date ............... Att~.~.s.t... 20 ......... 19 ~'~.. THIS CERTIFIES that the bu,ld,ng located at .... ~/S.....~...Ave .............................. Street Map No .... conforms substantially to the Applicat,on for Building Perm,t heretofore flied ,n this office dated .................... ~.a~...~] ............. 19....~'~ pursuant to which Build,ng Permit No ..... Z..~P.]. .......... , dated ............... ~. 22 .......... 19.~.~.., was ,ssued, and conforms to all of the requ,rements of the app[iccble DrOVeS,ohs of the Iow The occupancy for which th,s certificate is issued is ............ ........................... P~RI.VA~.E. DW'ELLIN~ ...................................................................... Th~s certJficote ~s ~ssued to . .~ertl~e....~e~l. ....... (.o~lr~p.) ...... : .............................................. (owner, lessee or tenant) of the aforesaid building Building Inspector Peri Inspector Fn.~ NO. B vowN o~ BUILDING 'D~ARTMEN T TO~ CL~R~S OFFICE SOUTHOLD, N. Y. BUILDING PER, iT CFHIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 321~ Z ~ote .................... ,11~.....,~ .................... ~.~'R. niss~on is hereby granted to: ~ ~e~e ..... ~¢.....~.~e..,..~h~. ...................... .............................. ~_~. ........................................ ~t premises I~ted of ...... ~...~ ................................................................................................... ..................... ~ ...................................... ~t~'~" ...... ~,'~', ........................................................ pursuant to a~p[icatton dated ............................... ~,.~ .................. 19..~., and cpproved by the .......... r ........ -",;,d,;;"i;;;~,or ...... FOI~M NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .......... ~.. ........... :~ .............. 19 ........ Approved ........................................ 19 ........ Perm t No ............................... Disapproved a/c ..... ~';'.~.....;~'4 ............. ..~ ............ ~ ........ .j;,,q ............ ~ ........ ................. ...... ........ (Building Inspector) Application No. '~/'~'- / ..... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in bv 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 layodt of property must be drawn on the diagram which is part of this location. c. The work co~ered 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 o 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, additior~s or a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 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. M~ap No: _. ........................................... Lot No: .................... Street and Number ...... /~......~....,.~......~..'.~.., ................................................. -- '-D'' ~/' Municipali~/ 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...-./......~/~,/~.~l..0....~.r......~..~ ......... : ...... ~..Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ...........~..,: ........: ,o?';"Number of dwelling units on each floor If garage, number of cars .........~...~.~.i ................................................................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Frant.....i.,~;~.t~:~.... Rear ............................Depth ............................ Height ............................ Number of Stories ......... T~,v.~./~. .............................................................................................. Dimensions of same structure with alterations or ~ddltions: Front ................................ Rear ................................ Depth .............................. Height ........................... ~,.).N~mber of Stories ................................ 8. Dimensions of entire new construction: Front ......... ~..../. .......Rear ....... ~....~....'. ......... Depth .........~.....~.....t. ........ Height ~...~¢~V~. ..... Number of Stories ............. ' 9. Size of lot: Front ........~..~..~. ........... Rear .............. .......... Depth ........................... 10. Date of Purchase ....... ~"~*/~¢'"~",r ...... ~"~"J ......... ,,Nbme of o ~er Owner ~ ~ ~Z. ~ 'i F r ................ 11. Zone or use district in wh~premises are situotedi.~:' ...... :..~....../.~..': ....................................................... : ....... 12. Does proposed construction violate any zoning law,~ ~dinance or regulation.> ........ ~ ............................ 13. Name of Owner of premises . ddress .......... Phone NO....~.., .~.~... Name of Architect ....................................................... ;A~ldress ............................................ Phone NO ..................... Name of Contractor..~.~L.~.~~.....:A'ddress .~.,~.-....Phone NO...~..~....~./... PLOT D kAGRAM Eocate clearly and distinctly afl 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. I~ J~0 I ~J I / STATE OF NE~_.Y-qRKad,, ) S S COUNTY OF ,~ ........ ) ' ............ ~~~'~/'~ ...................................... ibeing duly sworn, deposes and says that he is the applicant (Name of individual signing application) above named. He is the .............. ~ ................................................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perf~_~ave performed the said work and to make and file this application; that all statements contained in this,~~ true to the ~st of his knowledge and belief; and that the work wi I be performed in the ~nner ~,~ ~ ~)$etion filed therewith. Sworn to before me th~s ~. ez/e~?~t~ ~/4~.~. ~ /~ ~ ~ ~/ day o~ ..... ~.?.~ .............. 19...{..~ .... '~te*% ,~ueZ~gnature of app cant) .....................~~~-- ~ · o~ ~ .