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Home My WebLink About878-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~.S~..]~[~.t~..~.~.~.tllGk. t...~...~'~k~t M~,...~.."C'_~..~.O.~ack No....*..*..*. ............... Lot No..~' ............................................................ conforms substantially to the Application for Building Permit heretofore flied in this office dated ................ 1~3~...~6 ............. , 19~...., pursuant to which Build,rig Perm,t No...J~..~'.~ ........... dated ................. 0~t~e~...~,0 ............. 19..~.c).., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................ .................................................. ]?~ z~rJL~,~...0~.. ~A~FZL~'.. D~fr~LLZ~ ............................................. This certificate is issued to ....~.~l~..~[e...]~O]i~...~lt ....................................................... (owner, lessee ar tenant) of the aforesaid building .................. C..~cr... ................ ;~. Building Inspector \ FOF,¢~ NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PFRMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 878 z Permission is hereby granted to; Date .................. 0~...;~0 ............. 19.~).... to. J~u.t 7,,d..au..ar1~£t~,, .~.aa.-_?_~ ,~,~ ,,~..d.~md.~g ............................................................ at prem~,es Iocoted ct ,.~. ~...~....]I~.~..~,IK.~'~I.J'~ .]~k'~'.'~,~, ....................................................... ....................................... ~.tl~..l~o~l.~ ..... J~iatti.~k~....~. ......................................................... pursuant to apphcot~on doted .............. .l~.t,~....]~. ......................... 1~ ....., and opproYed by the Building Inspector Fee $~...1~. ................ 1'~'~' Budding Inspector FOR~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved... ... .., Permit No .... ...... Disapproved a/c ............ ;, ...... :.:. ................. ~ ......................................... (Building Inspector) Application No......~....~....~.... ........ APPLICATION FOR BUILDING PERMIT Date ....... ~'.C~...../. .................................. 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 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 alterations, 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) .................. (Ad .......... ................................... State wheth,er applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ~ aamp;, ::a :; :: ra° fcc: rpeo rmv::; ':','~:':':l~'c ~;':': ~' '~' ''~'~' ...................................................................... (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ~g(~..'2~ .~.~ot No: ..~.....~7. .......... Street and'Number ....~.' ~....~.~..,...~.~~..=....b...'..~.., ....................................................... ~) Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~ .'-.,;.;.~.. ~.~ ................................................................. b. Intended use and occupancy ............ ~.~......~.......c~....~......~.. .................................................. 3. Nature of work (check which applicable): New Building .................... Addition ...... /.: ........... Alteration .................... Repair ................. ...~emoval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .......... .~..:~....~.....:...~....m.. ......................... Fee ................ ~..:..~...~ ............................................................ (to be paid on filing this application) 5. If dwelling, number of dwelling units.....(r:z~4~- .............. 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 ..J...'~. ................... Number of Stories ..... ~ ............................................................................................. Dimensions of same structure with alterations or additions: Front ........ ,,~..~ ............... Rear ....... ..~........'24~.. ............. Depth ...~..G .................... Height ...... t...'~. ................. Number of Star!es ...... ~ ............. 8. Dimensions of entire new construction: Front ............................Rear ............................ Depth ............................ Height ............................ Number of Stories ............................ 9. Size of lot: Front ...........?...D.. ........... Rear ........... ~..~. .......... Depth ....../...('~...~ ............ Purchase ...~ ../...~..~..-~..-... Name of Former Owner .....~....~ .................. 10. Date of((,~Jin which"premi s are '~ii~i~ ..~..~ ,..~,~ ~ 11. Zone or use d~stn se 12. Does proposed construction violate any zoning law, ordinance or regulation? ......... ~(t~....~. .............................. 13. Name of Owner of premises...~z;..(/4:~,,~-,~l%~.Address ........ .~.,..Phone NO ..................... Name of Architect ........................................................ Address ............................................ Phone NO ..................... Name of Contracto~-~~: ........... Address ..~..~./..~..:y..Phone NO.~,~.~...-.~..'Z.~__ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate ali 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 NEW ~OR~(~ ,,~), S S COUNTY,~_~ ~_ -~-Z~ ~OF~) ' ..... ~~:~~: .......................... being duly sworn, deposes and says that he is the applicant (Name of individ~.. ~a~;ation) 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 ~st of his knowledge and belief; and that the work will be performed in the ~nner set forth in the~pl~ation filed~ew~h. Sworn tobefore methis ~ . ~ ( ~ I) ~ [ ( ~, (/ _ ~ ~ ~ nf ~~ 19 ~ (S gna~ure of app cant) ..............~ . ~.] ................... ~ ~~~'' ' '~''~ ...... JUDITH T. ~KEN Notaw Public, ~..~...:.~..~.~ ~No. 52-03~4~83, Suffolk County