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Home My WebLink About884-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 .~.~.~..~..~.~.~...~.~'.~..~.~..~.~....~...~..'~.~?~...9..~..t...N..?.~3?reet Map ~.*..*. ..................... Block No ...... .*...$..*. ............ Lot No ..... .*..?..$. ...................................................... conforms'substantially to the Application for Building Permit heretofore filed in this office dated ................... ..0..~...~..O...~....~.....~..~.. ......... , 19...~..~., pursuant to which Build,rig Perm,t No .... ..~.....~...~... .......... dated ...................... ..0..~...~..~...'1~..~....~..~. ....... 19..~.~.., was ~ssued, and conforms to all of the requirements of the applicable prowsions of the law. The occupancy for which this certificate is issued is ................ .................................................... ~, ~./~...(}I~.. ~.~.. ~.~.L~.~..(~ ............................................ This certificate is issued to ..~.~l/,t....~.~..~.~.~...~..~.[~9.~..~..l~...~...-~..~.~. .............................................. (owner, lessee or tenant) of the aforesaid building. I~uildmg Inspector HOWARD M. FO~ 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? 884. Z Date ................ 0ot,,.bez~....2,.T .................. 1~9 ..... Permission is hereby granted to: ...~t~h~g~e,....~^~A ................................. to ~Bu~.~t..ne~. ~el~Lin~ ............................................................................................................... at premises located at . . ~Ict..,?e. lt .,~.n~. ~ ~o~ell..~Zaee...(..L~:~u~.J~a:t.t,:Le~r..~t;~.~ .......... ..................................................... ~.t. ~.~..~.. ~j.... ~..~ ~. .......................................................................... pursuant to applicahon dated .................O~t4~.. 22 ................... 19~9....., and approved by the Building Inspector Fee $ .t.L.~.~,...f~. ............. -- Building Inspector FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ ]9 ........ Permit No ............................... Disapproved a/c ....~~...T~.L ....... r'~ .......... ~ ........ ........ ................... App,icotio. ............ APPLICATION FOR BUILDING PERMIT 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 o 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 port for any pu?pose 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 Lows, Ordinances or Regulations, for the construction of buildings, additions or a Iterations, or for removal or demolition, as h~rein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. (Signature of applicant, or name, if a corporation) .......... =~ ................ .(-...-~;~s.;'-~f- ~olica nt...-'- .~.. ~)......-*-.'...~:] / ................ State whether applicant is owner, lessee, a~,ent, architect, engineer, general contractor, electrician, plumber or builder. ................................................................................................... Nome of owner of ........................... If applicant is a corporate, signature of duly authorized officer. (Name a. nd title of corporate officer) 1. Location of land on which proposed work will .4~e done. Map No: ......... ,e, ................................ Lot No: .................... - ;~ ~' / ~. street and NumberQ''~'''' .~....~~,..~""~'"~"~,~"~~~ MuniciPality ~ ' 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and oc~:upancy..,~,<. ............. :2 ......................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ............. .:~...Removal .................... Demolition .................... Other Work (Descr be) 4. Estimated Cost..L...~...~../....~~ 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 ................................ ............ i ........ .... z" 8. Dimensions of entire new construction: Front. ~ - Z Rear ............ Z ............. Depth ......¢~'.:.~....~.'...~...~ .... Height /:~ ~' ~-~/' Number of Stories ....... ~ ........ Size of lot: Front ../...~../,~'~ x '~' ~"'z' .......................... Rear ..... ~.,...~ ...... Depth ......J...~.. ...... 9. 10. Date of Purchase ........................................................ Name of Former ~'~' ..~.~. ~ , ,~'~ Owner ............. ~. ...................................... 11. Zone or use d~stnct m which premises ore s~tuoted ........ d. .......................... ]2. Does proposed construction v~iolote ony zpnin~., Iow, ordjnonce or regulation? ......... .~.~ .................................. 13. Name of Owner of prernisesc~'Z~f '.~_,~. .............................................. Phone NO ..................... Name of Architect ....... ,v~ ......... -....;~...?..;....~...:.....Address ........................................ Phone NO ............ Name of Contractor..~4~.~.~~....Addres~__~]~.~..,~~ NO~.;..~..q~.~'i.~.~.,~ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-bock 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. sz, Z OF EW s s ~uu~~ ~~ u~ ........................... J .... ~.~~ .................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing~~ above named. He is the .......................... ~.~~ .................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owne~, 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 ~owledge and belief; and that the work will be performed in the manner set forth in the applica~ filed t~ewi~ Sworn to before ~e this ~ / ~ , / ............ ~..~day o ............~~.. 19.~ .... ~ 9 ~0~(Si~ature of applicant)