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Home My WebLink About913-zFOP~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...~..,1,~3. .......... Dote ........................ u~Ul~..,~ ................., 19..&2. THIS CERTIFIES that the building located at ..... e/~l...ZO~t,~g~..Al~...~l.O~l,~Lol~[ ..... Street Map No ...... ..e..~..~. ........ Block No ......... .e.~.~. ....... Lot No ......... ~*.t ................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. ~1~e;~...24 ...... 19...5~ pursuant to wh,ch Building Permit No....~...?..1...3.. dated ....................~'~..et~1~,1~..24...., 19..~9., was issued, and conforms to all of the requ,rements of the applicable prowsions of the law. The occupancy for which this certificate is issued is .......... PI~IVATE ~ FA~,Y DWELLZNG h,s c rt,f,cate sued to ...... ............................................................... (owner, lessee or tenant) of the aforesaid budding. Building Inspector FO~M NO. ~ TOWN OF SOUTHO/D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT N°. (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 913 Z Permmsion is hereby gronted to: ......... ~,. .~,~, ........................................ to .. ~t~t.~..~t~.~..e~..~..~...-~...~.e.~...s~. .................................................................... at premises located at ~.~f,~..Ro~..~J~.Z~l~l~S.,l['l~e .................................................................. ...................................... I~~...lo~ .......................................................................................... pursuant to application dated ..................... ]lll~:.~ ..... ~ ........... 1~. ..... , and approved by the Budding Inspector Fee $..~,,00 .............. FO~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE- SOUTHOLD, N. Y. Exom,ned , Approved ~...~..~..~....~...~..., 19..~..~..~ermit No ...... ,~'..~..~..~ ........... ............................. i /fiii i; ' ................ APPLICATION FOR BUILDING PERMIT 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 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 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 o Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment 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 oil applicable lows, ordinances and regulations. /f~ignature of applicable, ,o~'m.e, i~ corporation) (Address of applicant) State whether applicant is owner, lessee, a~~engineer, general contractor, electrician, plumber or builder. Name of owner of premises ................................................................................................................. If applicant is a corporate, signature llgf duly .au~orized~ officer. .... . (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number ~ty ~ / 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 ...................... ...~.........~..~.......~... .................................. ~~~... 3. Nature of work (check which applicable): New Building .................... Addition ........ ~ ....... Alteration ...... ;....: ........ Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Est,mated Cost ....... "---- ......................... 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 af each type of use ................................ 7. Dimensions of existing structures, if any: Front ................ ~.~..... Rear ..... .~....~.~. ............ Depth ...~.~.. .................. Height ............................ Number of S~ories ...... Z....//'~.. ...................................................................................... Dimensions of same structure with alterations or additions: Front ................. .~...c~-.... Rear ..... ..~...c~. ............. Depth ............... ~.....~.. ..... Height ................. ...~.~ ......... Number of Stories ........./....~,9._~. ...... new construction: Front .......... ?//-~'"' ........... Rear ........... .~..... ........... Depth ....... ...~....~-? .......... 8. Dimensions of entire Height ............................ Number of Stories .......~..../....,~¢ 9. Size of lot: Front .......... g...~.. ....... Rear ................. ~--~...~... Depth ...... : ./....,~..~. ........ 10. Date of Purchas~..~..../'...~..~...~.~... Name of Former Owner ........ ~; ../_~~.._ 1 1. Zone or use district in which premises are situated ....................................................... 12. Does proposed construct on voate any zonina law ordnance or requaton~ .4 13. Name of Owner of premises. . ddress ....: ................. .~,.)...~..... P~h,~'~-6 ..................... Name of Architect .... ~ ...................... ;~....~....<...~,...Ad,~ss ........ ,~ ............ ,~ ................. Phone NO ..................... Name of Contract s ~r. ........ 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 corner lot. STATE OF NEWA.~I~./TZ~ ,) S S COUNTY OF~/:~'t~.~-~Z.~..) ' " /~ · ,~ ..................... ~-~..~ ............... being duly sworn, deposes and says that he is the applicant (Name of individual sign~g application) above named. He is the ......... ~ ................................................................................................................ (Contractor, agent, corporate officeG 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 statemen~ contained in this application are true to the best of his knowledge and belief; and that the work will be peFformed in the manner set forth in the application filed therewith. Sworn to befor me this JUDITH T. ~K[N Ho '~-0344963, ~u~lk County ~/ ........... ,.., ......... o o, ..... ....... .... ~ot~, Public, .~~~~... ~ (Si,n~turo of opplicont)