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Home My WebLink About892-zFOR~ NO. 4 TOWN O.F SOUTHOLD BUILDING DF..PARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..[Jj'-EI...J~O~'.~;~..J?~'$1~IQ,..J~.~.~.e ............. Street Map No 8~.~'~ ............ Block No...~r~ ............... Lot No. ~ .........SOLI.t~O~C~....~,.~', ................ conforms substantially to the Apglication for Building Permit heretofore filed in this office doted .......................... ~D~gm~.....~..., 19~.~..., pursuant to which Building Permit No .... ~..~.~,o ........... dated ........................ ~O~f~J~fL1~.....~... 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'.:L'va, t,~..one...f.~:t,.l¥..~e;/.1~.~.,j~ ........ (..~he'J.;1,..e.n],-y:-) ............................................. Th~s certificate is issued to ....j~.l~l~..~J;J.~li~.~..~.~, ........... (...~'~..) ........................................... (owner, lessee or tenant) of fha aforesaid building. Building Inspector -'"'f FOR~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N: Permission is hereby granted to: (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 892 Z Date ]go'~e~l~l' /, ot premises located at ~..."..o......!!,..~...?.t...~.k....~...~...~ ~...... ................. pursuant to opplicotion doted ........................................................................ ond opproved by the Building Inspector Fee $..~...0..-.,.0~....~ )~'~ Building Inspector FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved..../~.~~.I,¢...Perm,, No ....... ~./...~.. ........ ............ (B~,~,ng'i~sp;~;~¢ .............. Application NO ..... .~..~..~ ....... APPLICATION FOR BUILDING PERMIT Do....../..¢...0..'.¢..:......~'. ............................ ,,.:..~... INSTRUCTIONS o. This opplicotion must be completely filled in by typewriter or in ink ond submitted in duplicote 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 drown on the diagram which is port 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 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 o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment.for the issuonoe of o Building Permit pursuant to the Building Zone Ordinance of the Town of Sotxthold, Suffolk County, New York, end other applicable Lows, 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, z (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is.,a-~orporate, signature c~f duly~outhorized officer. ~corparate officer) 1. L~ation of land on whic~ proposed work will b%done. Map No:~~.~~'-Lot No: ..Z.~ ............ ,,,~e, .,, ,,~., ~.~....~..~ ............ ~ .................................................................. . ¢, .............. Municipality State existing use and occupancy of premises and intended use or{d occupancy of proposed construction: a. Existing use and occupancy ..............,...; ................................................................................................................. b. Intended use and occupancy ......... y~...~..,~.:.<.'.z~...~'.~...~...~..; ..................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... (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, speci~ nature and extent of each type of u~ .............................. 7. Dimensions of existing structures, if any: Front ............................ Rear ............................ Depth ............................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with alte~tions 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 .... ~.~ ............ Rear ...... ~.~ ........... Depth .~.~ .............. Date of Purchase ..... ~.~ ............................. Name of Former ~ner .~..~:E~..~ .................. ]0. 11. Zone or use district in which premises are situated ....... ~..~..~'~.~ ......................................... ...... ..................................... 13. Nome of ~ner of premises.~~~Address ~~.~.~,......Phone NO ..................... Name of Architect.....~ ................................................. Address .......................................... Phone NO ..................... Name of Contracto~.~,.~~.Address .~ .......... Phone NO..Z~.~ .... PLOT DIAG~M 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 .............. lot ................. ..~~:.;~./~......:. ............... being duly sworn, deposes-~nd says that he is the applicant 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 best of his knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to bef~r~e me this