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Home My WebLink About370-zFORI~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .~...~.1.)}. ........... Date .............. ~loveml~e~.. g ............ 19.~&.. THIS CERTIFIES that the budding located at ]~r.t,. Rd ..... N/~. So~md...Ave .............. Street Map No .... ~ ............. Block No .... ~ ........ , ~: conforms substantially to the Apphcat~on for Building Permit heretofore filed m this office dated .................... ,,T~q.e ...... ]0 ........... 1~..., pursuant to wh,ch Bu,ldmg Perm,t No ....... ~...~O ......... , dated ................ J~.Zlte.....~0 ...... 19..~., was ~ssued, and conforms to all of the requirements of the apphcable provisions of the law The occupancy for whJch th~s certificate is ~ssued is ............ .......................................... ~t. TI/,~.:F,.. D~,~&~,.I ~(~ ..................................................................... Thls certificate is issued to ..... ]][&]~]LC~ ~-.e~.~'~]3. .... (..~)~.)....: ........................................... (owner, lessee or tenant) of the aforesaid building .:..~.. ........ .c.:.~ Budding Inspector FO]~ NO. 2 TOWN 0~ $OOT~OLD BUILDING DEPART/~ENT TOWN CLERK~'S OFFICE SOUTH~LD, lq. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 370 Z Permission is hereby granted to: ~ld .~ea~el~ ........................................... ............ ,1.~ ...... ~.. ~.11...~ ............ .................. ]aas~l~',~....He~t~t~s ................... to ............. ...~....i...Z.~....~...~.d..cl;Lt~...~u..~u ..~a.~z~.. ~,~,~ ....................................... at premises located at .-.~&te.--P,O~d! .... N,/S .. ~I11~. A~'e ..... ~o~p:~..,q~c~.~_~-.Y,~l,) .... .......................................... Jl!att~tnek~ ....... I~,~, ....................................................................... pursuant to application dated .......................... ~....~...~1 ................... 19~..., and ~pproved by the Budding Inspector Fe, $..~,.00 ............. FORM NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Exammed......~ ................... 19 Approved ........................................ ]9 ........ Perm t No ............................... APPLICATION FOR BUILDING PERMIT Dote ............. ........... 19....?....Ff.. 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 a detailed description of layout of property must be drawn on the diagram which is part of this location. c. The work covered by thls 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 occup;ed or used Jn whole or Jn 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. .... .... .... ................... ~ n (Addl'~ss of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......... marne or owner or premises ....... 1.....% .................................. .~¢.. ~. ............................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed york will be done. Map No: ............... .'. ........................... Lot No: ..'. ................. Street and Number ..~.~. ............. ~.~..-(. ....... ~........ ......................... ~.....~~ ............... 2. State existing use and occupancy of premi~and intended use and occupancy of proposed construction: a. Ex~stmg 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...,~..(~...~...O......'..?~.. ................................. 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 ............................ 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 ...../..~....[.~....i~ ........ Height ............................ Number of Stories ............................ / 9. Size of lot: Front .........¢~........~. ........ Rear ............................ Depth ................... 10. Date of Purchase ................. /....~....~.~....7.-. ................. 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? .................................................... ]3. Name of Owner of premises...~...r-Z?....~...t~.....~...Z~.....Address ............................................ Phone NO ..................... Name of Architect ........................................................ 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 accordin whether interior or corner lot. to deed, and show street ~np~es and indicate 11 STATE OF NEV~Y~, ,, ) S S COUNTY OF ...~.°~...r..R~../.~.....)~ '~,__ _ !, I~' ' ............................ · (~C~....~' ' .......... ~- ................................. e ngi duly sworn, deposes and says that he 'is the apphcant (Nome of individual signin~,application) ,c' / obove named He s the (-~'~- J~..~.:....~..~.~" ...~-..~.~.. q~ ~ /(Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized t6 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 applicatip~ filed therewith. Sworn to before me this (-~ a..__ ~ {; ........ ~...~...~...~.'.. da~ of ........... ,,~,J.~.ce,,..l~...~s-~._~_~'~,~ ~,, '" (Signatu~ of applicant) Notary Public, ...q',,~C~t~.f~Z-~,~.~/......~..~.CoTu"t~f~ ~ ~ ~ ~ ~