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Home My WebLink About328-zTOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .Z..~L~7. ....... Dote .............. Sapteml~en. lQ .......... 19.~.. THIS CERTIFI~:S that the building located at .... ~e-~t,...~i~W.. D~'.J[,lte ................... Street Map No ........ ,~,~;~x ......... Block No .......... conforms substantially to the Apphcat,on for Building Permit heretofore filed in this office dated ........................... ~f~r.... ,o~. ..... 19..~[8., pursuant to which Building Perm,t No .... ..~...,;]..~..~.. ............ dated .................. 1¢__~'....2.~. ........ 19.~i~ , was ~ssued, and conforms to all of the requirements of the apphcable provisions of the Jaw, The occupancy for which this certificate is issued is ............ ..................................... PI~, I.V.~ ~ .F, . DU.ULL3~G ........................................................................ This cerhficate is issued to ... ~et~.~.....~,~rk~ ...... ~../o~/~ez:) ................................................. (owner, lessee or tenant) of the aforesaid build~:g Buffding Inspector N? FORI~I NO. 2 . TOWN OF SOUTHOLD BUILDING DEPARTMENT TO~VN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT' ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 328 Z ~ission is hereby granted tot , A. Retll~...&..Sc~_ ...A/~....,l~Jta,~y...~eu:'~:t~ ............... at premises locf~ted at .... ~/~ .~e~J~V~e~ .~t/e ..... ~.-~o~. ~:~) ................................................. ..............,I ......... :. .............................. l~a~tt.tuc]~ .... II, Y., ............................................................. pursuantjto appli.cot,on doted ........................... ~..27 ................ 19 .~., and approved by the Building Inspector Fee $.,],.0.~.00 ........... FO~L.~ NO, ! TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exomined ............................ ,.~.,..'7.,.. 19.. ~,. ~e'~ A~prove5 ........................................ 19 ........ Permit ~o ............................... {Buildinfl Inspector) Application No ............................. APPLICATION FOR BUILDING PERMIT Dote ....................... ~,, ..~......~.......~.. · ........ 19....'~....~.~... 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 adjoining 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 covered 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 through'but 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, additions or o 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) (Address of opplicant) Stote whether applicant is owner, lesseeAagent, architect, engineer, general contractor, electrician, plumber or builder. ~aam;pl ~a °n~V~ra°fcoP rjorm~:[i' ';i';' ~notu re of duly out t~ 'o';[ ';:';"':; { ~e r. ~f~ ..................................................................... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ........... Lot No: ..,.~., ........... Street and Number ...~..Z.~..:.....~.-~... ..~..~ .......... ~'"',"'""[ '"~'"'"~~('"' "~'"~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Exlstin§ use ona occupancy ..................... * ......................................................................... b. Intended use ond occuponcy ................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... ..~.......':m...u.% ................................... Fee ..[..0. .................................................................................. (to be paid on filing this application) 5. If dwelling, number of dwelling units ........... ~.....Number of dwelling units on each floor ............................ garage, number of cars ............................................................................................................................................ 6. If business, commercial or mixed occupancy, specify n~ture 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 ....~..~.....Q ............. Rear ....... .f...o....o. ............ Depth ?..~...~.......? 10. Date of Purchase ......... ~..?.:..5....~... ............................... Name of Former Owner '""~.~ .................... 11. Zone or use district in which premises are situated ........... 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ..~/.....O. ................................... 13. NameT, O~Owner of premises.~.~...~.....Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contractor../~..}~.....~..-a~..~.'...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 NE~/,~YQP/K.~ ~._ ) S S COUNTY OF ~.....) ' ...................................V~ /~ ~..,...~ ................................ being duly sworn, deposes and says that he is the applicant (Name of individual signing dpplication) above named. He is the ................................................ ~..c..~.~j]] ................................................................. (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 4~hj~.,~tpplicatlon are true to the best of his knowledge and belief; and that the work will be performed in the,~mame4~,~,~?J~, in the application filed tl3i~with. Sworn to bef re me this · '?e 4( ~'%~-~?~ '" -j° o o;~ ..... ~...~.o.~.. day of ......~.~ ............. 1c~:'.~'~?'~ ~re of applicant, Notary Public, ~.~.~. .............. County