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Home My WebLink About344-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ti. Y. CERTIFICATE OF OCCUPANCY No ...... .~....~.?..?. ..... Date ........................................................ , 19 ........ THIS CERTIFIES that the budding located at ..~../..~....~..9.[..~..~...~....~..9..~...~.~....~..O...~...~:...,O...~..~.. ...... Street Map No]B~eI~.~,f:~ ...... Block No. ~t , 5 ........................ Lot No ................................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated 944 ....................................................... , 1~..7....., pursuant to which Building Permit No. dated ..................~..~..~..?...?. ....................... 58 19 ........ , WaS issued, and conforms to all of the requirements of the appticab[e provisions of the law. The occupancy for which this certificate is issued is PRIVAT~ ONE FAMILY DWELLING This certificate is issued to N~OI.&II Igab,~-~e, (owner, lessee or tenant) of the aforesaid building. BUILDING PERMIT Qr'HIS PERMIT MUST BE KEP~T ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED} N.° ~ 34~' Z Pern iIssion is hereby granted to: Date ............... Z~.~"7 ................. ~9~8 .... at premises located at I ..... ~'l~'-'"~l~"'"l~r ' '~"~"~ 'F~"'~'~'~'di~ ............................ pursuant ~o applicat,on doted ................... ~f~[~J"7 ............................. 195~...., and approved by the Budding I~nspector Fee $-~.,-Oe ............. FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ~' ' 't No. ~ '~ ~-/q Approved ........................................ 19 ........ Perm .............................. Disapproved a/c ............... ~...~, ........... ?"t. ............. 7"'"' ............. ; ........................... ............................... ........ \ ............ (Building Inspector) Application No ...... ~..?.. ~. ............ APPLICATION FOR BUILDING PERMIT Date .................. ~.....12 ........... i9.~ .... 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 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 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 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. ...... ....................... (Signature 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. i'~*~'i"~f owner of premises ~..~.Z.......~.... ,,~..~..~.. :2 .~.. ...... ...~...~ .................................................................. 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. Mop No: ..~..~ ............... ,;.... ko ,p~ : .................... _ ~/¢ il2.,~...~ ,~,,,,_.~.-.. ~~'.~.. ~Z, Street and Number ~.:/. ,~......~..~,..~-~'z.z,..~ ........ ~..~¢.~ ....... ; ....................................................................... Municipality 2. State existing use and occupancy of premises anc~L intended use and occupancy of proposed construction: a. Existing use and occupancy ......................... ,.~~..t( ....................................................................... b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition J Alteratio Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost....."7...~...~......~.....~.._D..~. ............................. 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 ~ C~ ~ 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 ...... . .,~..~ .............. Depth ..~...~..'. .................. Height ............................ Number of Stories .... ,J...~ ........... .... 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 ...... ./....~....~..~Z.. ........ Rear ....... !...~'......~........._ Depth ~ ~" 10. Date of Purchase ............. ..~...~....~....'~.. ............................ Name"of Former"Owner'.~..~.~-- '"'"'"-::'-'";'r'. ~ ........ 11. Zone or use district in which premises are s tuoted .......... : ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ........ .../~.....O.. ............................... 13. Name of Owner of' premises. J..V..~...~.~:;::..~. ..........Address ............................................ Phone NO ..................... Name of ' ' ~ Arch~tect...~ .................................................... Address ............................................ Phone NO ..................... Name of Contractor .................................................... 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 NEWo O , ) S S COUN OF ..................................... ~.~.: ............ ' ......................................... ~emg dul~ sworn~ deposes and says that he is the applicant (Nome of individual signing application) ' ' ' above named. He is the ................. ~~ ............................................................................ (Contractor, agent corporate officer, etc.) of said owner or owners, and is duly authorized to I~rform or have performed the sa d work and tol~qake and file this application; that all statements contained in this application are true to the best of his knowe~rge and belief; and that the work will be performed in the rnanne~s_et ~tel) in the ~:~cation filed therewith. // · Sworn to before me this ~ "~_ ~1~~ Bown.- ~ # ............ day of ............. Notary Public, .-.~...J.~~'t~ ~ ~'~ ,~