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Home My WebLink About923-zFOH~/ NO, 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOI.D, N. Y. CERTIFICATE OF OCCUPANCY No ~ 622 Dote ~U~e 14 60 THIS CERTIFIES that the, building located at .~/./lI,..~.~4~.~...~.~...~.~'.~.~...1~I~.,.:~, ........ Street Map No. **w Block No, *~* Lot No *** conforms substantially to the A~lication for Building Permit heretofore filed in this office dated .............. ~.~..~. ................. , 19..~.~., pursuant to which Building Permit No ...... ~...~.~ ......... dated. ~e~ ] 19..~.., was issued, and conforms to oil of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued is ................ .............................................................. .................................. This certificate is issued to ~ ~~t~ ~ (owner, lessee or tenant) of the aforesaid building. Building Inspector ~"0~ ~0. 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.o 923, Z Permission is hereby granted to' ~..~?....~... .......................................... ~._.~.....( ..~....~ ....~). .................................. to I~I~.~L~.~..~...~-~,,..~..~,~..~..~...~....~ ............................................................. pursuant to application dated ....................... J~l~lllq~l~..] .................... lC).~..., and approved by the Budding Inspector F~e $f,.~...~.~0~1 TOWN QF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ~4~,....~.. ............ , 19...~..~ Approve~..,~---~.., 19~..Permit No ........ ~?...~... ...... Disapproved a/c ........ ~ ........................................ ~ 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 a detailed description of layout of prol~rty must be drown 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 part for any purpose whbtever Until a Certificate of Occupancy shall have been granted by the Building Inspector. ~.r~ ~ APPLICATION IS HEREBY MADE to the Buildi_ng Department for the issuance of a Building Permit pursua~o the Building Zone. Ordinance of the Town of Southold, S~ffolk County, New York, and other applicable Laws, Ordinances or Regulations, tar 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 o'~F-oppli~l~(or name, if a corporation) . .... (Aa~dress of applicant) ~/ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.....~~ .......................... i. ............................................ . ............ If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which pmpo~sed work w~ill be done. Map No: ..~ ......................................'. Lot No: .......... ...'"'~. ...... -/ Street and Number .......... ~...~ ........~...~.-..~.....~...~..~ ......................................... / Municipality 2. State existing use and occupancy of pr~n_ ises and intended use and occupan~cy of proposed construction: a. Existing use and occUpancy ......................................... ~. ................... b. Intended use and occupancy ................................................................................. / 3. Nature of work (check which applicable): New Building .................... Addition ........ ~....Alteratlon .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost .......... ...c..,~r/~...~.~ ................................. Fee .....,.~ .............................................................................. (to be paid on filing this application) $. 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 ...~..~..~ He ght ............................ Number of Stories ............~...~ .............................. 'X ..................................... . . . ~ ~ / ~ ~ 7 ~ ...... ~' Dimensions of same structure with alterations ar additions: Front . .. .~.. /_ .. ......... Rear,..~......~... ....... Depth ....~...~...~ ............. Height .................... L ........... Number of Stories ....... ~.~..~...~. 8. Dimensions of entire new construction: Front ...... ~.~....~ ....... Rear ...... ~.~.....~ ..... Depth ...~0 .................... Height ............................ Number of Stories .......... .~. .................. 9. Size of lot: Front ......~.~.~... Reor ...~~ Depth ...~.~.~ 10. Dote of ~urchose ........... ~: .......................................... ~ome of Former ~ner ........................................................ ]]. Zone or uso district in which premises ore situoted ......................... ~.~.. ............ ' .......................... 12. Does proposed construction~/J' / -~ _~ . _ ~A. ~ ~ ./~_~vi°~in~w' o~dinonce ~r [o0ul~tion? ....... ~_~..; ................................ ~*me o{ Architect .......... ~ ....................................... Address ......... ~ ........ ~hone ~O ..................... o, ........ ............. ..................... PLOT DIAG~M L~e clearly ~nd distinctly oll buildings, whe~er exis~in~ or proposed, ~nd indicate ell se~-b~ck dimensions from pr~er~y lines. Give street and block numbers or description ~ccordin~ to deed, and show stree~ n~mes and indicate whether! i~rior or corner lot. STATE OF NEW~'O.I~J~ (Name of ir~lividual si~d. ng oppli~tion) above named. He is the ......... ~..~ ....................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly autho;'ized 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 t0'before me this ,~ / . ......... Notary Publict~-~..~ ~