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Home My WebLink About879-zFORM TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at. e/m..3%~Le~../kv.e~ue.~..ge.C.~£t;~O~c, Map No ~ Block No. *** ' ................................................ Lot No .................................................................... conforms substanhally to the Apphcat~on for Building Pe. rm~t heretofore filed in this office dated ........................... ~.'~I~...~.Q ...... 19.~?~.., pursuant to which Building Permit No. ~..~ ............... dated ......................... .CJ~3.t~g.~e~*...~,9....., 19.~.C~.., was issued, and conforms to aH of the requirements of the applicable prowsions of the law The occupancy for which this certificate is issued is .............. ......................................................... ...................................... This certificate is issued to .....~...~..~..~.~..[.~...J~'.~.~.l~...~..'e~4~. ........................................................... (owner, lessee or tenant) of the aforesaid buildmg Building Inspector HOWARD ~o ~ FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 879 Z Date ................ ~.C .t~l~,~. ~/0. ............ 19~.... Permission ~s hereby granted to: ~-~.~.e~.~ ..~, L. ~..~.,n,~.. ~.~:'.~ ................... to ...~$~....a..~.~,.t..t.~..o.~...o.~...e...x..t..~..t...~....o.~.e... ~..~...~~.~ ............................................ ct prem,s~es located at ..~..~...~..~...~.~....~..I~..~..'¢~..-~...~..tr.~.:~.~.l~'.~...~...~.~..~....~..O~..~ .................................. pursuant to application doted ...................... ~.~..9...1~..~...~...O. ................ 19.~.~.., and approved by the Building Inspector Fee Building Inspector FO~M NO. 1 TOWN OF $O~THOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved .... 'gA ermit ......... Disapproved o/c ..................................................... ........ .............................. APPLICATION FOR BUILDING PERMIT 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 o Building Permit to the applicant. Such permit shall be kept on the premises ava,liable 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 Bud ng Perm t pursuant to the Building Zone Ordinance of the Town of Southold Suffolk County, New York, and other app icab e Laws, etd nantes or Regulations, for the construction of buildings, additions or alterations, or for removal or demolit on os herein described. The opplicont agrees to comply with oil applicable ,a~s, ordinanc~s.~ulations. , ............. ...... ................. . State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of ~' (Nam~ and title of corporate officer) 1. Location of land on which proposed work will be done. Mop No: ............................................ L0f No: ...... .............. / ~-- (~ --~'"'~ Municipality 2. State existing use and occupancy of'~ .(--~ · ~premises and inten,ded use~,~ .,~.~ -and occupancy of proposed construction: Existing use and occupancy ...... ~~...~. ....................... i ........................ 3. Nature of work (check which applicable): New Building .................... Addition ....... '.J:~...........Alteration .................... Repair .................... Removal ....................Demolition .................. Other Work (Describe) .................... ..... / ~ ~ ~,.~ 4. mst morea t-asr Fee ~..~. ................................................................... (to be paid on filing this application) dwe n number of dwe n un ts /' um er f ' ' 5. If ' g, ' g ' . .............. :..~...Nun b o awe~ing 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 structu;es, if any: Front ...........~ ...... Rear ..... .~..~,~. ............ Depth ...'~..~ ........ Height ............................ Number of Stories ......... .~.. .............................................................................. i ................ Dimensions ,of s,ame structure with alterations or additions: Front .............. ~ ........ Rear ....... ~..~/...~.....'~.. Depth .o~.....~....~.....i Height ...................... ; ........ Number of Stories ..., .~.. ........................ 8. Dimensions o/of entire new construction: Front ....~. ~ ,,~.... .............. Rear ............ .~..~...'~..... Depth ..... ...~.....o~ .......... Height ............................ Number of Stories ............. ,~. ................ 9. Size of lot: Front .......~...--.~. ........ Rear .......... ~,. ....... Depth ....~: ........ 10. Date of Purchase ....................................... Nome of Former ~bvner ........................................................ 11. Zone or use d,str,ct.,n wh,ch prem,ses are s,tuated ............. ~ ..~..~ .................................... 12. Does proposed construction violate any zoni~a law, ord nonce or regulg,tion? Name of Architect~.~_~,~...~.~ ........ Address ~'~'-~i .......... .~..~-... Phone NO ..................... Name of Contracto,~.~...~...~s~..4..~./..~,. '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 c~rner lot. STATE OF NEW/X~O~I;~_ ,,~,~/~ ) S S COUNTY O . ............), -' -'! - ............. ~;~~......being duly sworn, deposes and says that he is the applicant · ' ~Name of ~vidual s~;t~ , above named. He is the ......... ~.~.~.: .......................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have ~rformed 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 wilt be performed in the manner set forth in the application filed therewith. Noto~ Public, ~~ '~:rZ ~pplicant)