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Home My WebLink About919-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY ~o. Z t+%3 Rte - ~9 ........ ]~Iallock l~le~ Ma~;tituek~ N,~. TI-tlS CERTIFIES that the building located at .................................................................... Street Map No ......................... Block No ......................... Lot No ................................................................... conforms substantially to the Application for Build,ng Permit heretofore filed in this office dated OOtO~Z' 2~ 19 pursuant to which Building Perm,t No. dated ............................... .~...e..~..e...~...~..e.?.....~l 9 ........ was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ................ PRA-VATE O~E FAI~LY This certificate is issued to D1~, H, Holtz~ o~er (owner, lessee or tenant) of the aforesaid, building. FORAY[ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS ~ERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 919 Z Permission is hereby gronted to. mm,~ o.~...~.~..~..~.L....~..q .~:...~..~.z.~ ....................... at premises located at ..(~r~...~..~,.~,]J....~..~...~...~ ....................................................................... ................................................... I1~.~.~.....~.~ ......................................................................... pursuant to opphcot~on dated ..................... (~t~t/:l~ . ~'/.. .................... 19~ ..., and approved by the Budding Inspector Fee Budding Inspector 1~018~[ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved... ./....I . Perm,t No ..... .......... Disapproved a/c .~~.....~..:...~.. .............. ./..¥..~....(...~..~..:... ~. ~f...~..~. ......... (Building Inspector) Application No .......,~.. ~..~... .......... 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 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 Buildihg 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) ..... .............................. ~(Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner of premises .......................................................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Ma~p No: ............................................ Lot No: .................... Street and Number ........... ~...~~....,....~~..?~.:..?~....,~,...~..~." '-- ~-- -- ......................................... 2. State existing use and occupancy 0f premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................... ~ .................................................................................. b. Intended use and occupancy ................ ~f~-~~ .................................................................................. 3. Nature of work (check which applicable): New Building .................... Addition ....... .:....' ...... Alteration .................... Repair .................... Re,,oval .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ............ .~.....~......~...~?.'....~... ......................... Fee .......................................................................................... (to be paid on filing this application) §. If dwelling, number of dwelling units .............. I' .............. 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 ................................ Reor ................................ 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 ............................ 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 l. Zone or use district in which premises are situoted....~, ..~.. ...-. ............................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ...... ~ ....................................... 13. Nome of Owner of premises ............... Address ............................................ 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. STATEOF NEWYORK, ) SS .................. .~..¥_.'~..,.'?.~~ ............................. being duly sworn, deposes and s~ys that he is the applicant (Name of individua~g,~,p~at~ion) above named. He is the .........~~Z. .................................................................................................................... (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 applicati~ filed the~rewit~h> , Sworn to before me this