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Home My WebLink About737-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located atl]l~t,~,..t~lt~.~'e..JJoJ~b .................................. Stree~t Map No..(J~:IIIILIJ~I~... Block No ......................... Lot No...¢J'/..~cJl~JcJt ...... J~.%~J~s....Ii~,Z,~ ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................ ~Tt~ ...~.?. ............... , 19.~..., pursuant to which Building I~rmit No ..... J.'l~Jt. ............... dated ........................... .~...~....~.......~. ........ , 19.~...., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy forwhich this certificate is issued is ................. ........................................................................................ This certificate is issued to ....g.~jl~T~..[i~lillJ~iRftl: .............. (...~11~..) ................................................... (owner, lessee or tenant) of the aforesaid building. FOI~M 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.o 737 Z Dote ............................ ~..~..........2~.. ............. 19..~..9.... Permission is hereby granted to: ~ .W.B~.~,~ & .~n~..~ .,~...... ~o~e~l~l...'~x~..b~t...e~ ........................ ........... ~..~_~.~.~.....~ :.~ :. ...................................... to ... ~,~..ne~.e~e..f~l~..~welll~ .............................................................................................. at premises located at ....Gaose..].?eok....~3.t...~l...c~.,..98,....~, .............................................................. ............................................ ~v&t~. ~.$~e...~.o.~,....~.o.~ k.~.,.~... .............................................. pursuant to application dated ........................................ ~TIIiI~...~. ....... 19.~.9...., and approved by the Building Inspector Fee $....10.00 .......... t~uilding inspector ~ I~O]IU~ lqO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No ....... i~.'...~...~! ....... APPLICATION FOR BUILDING PERMIT Dote ................... ...'~...~ ............ 19..'~.../~..... INSTRUCTIONS o. This application 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 ond of buildings on premises, relotlonship to adjoining premises or public streets or areas, and giving o detoiled description of layout of procerty must be drawn on the diagrom which is port of this location. c. The work co~ered by this opplicotion may not be commenced before issuonce of Building Permit. d. Upon opproval of this application, the Building Inspector will issue o Building Permit to the applicant. Such permit sholl be kept on the premises avoiloble for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for ony pu?pose whatever until o Certificote of Occupancy sholl have been gronted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuonoe of a Building Permit pursuont to the Building Zone Ordinonce of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulotions, for the construction of buildings, additions or o Iteration~s, or for removal or demolition, os herein described. The applicant ogrees to comply with oil opplicoble laws, ordinances and regulotions.~ -' ........ ......... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signatu~of duly .~. orized officer. (Nome and title of corporate officer) 1. Location of land on whic~h proposed w~ork will be done. Map No: ............................................ Lot No:~..~.~.~..?.~... Street and Number .~.~ ....... ~ ..................................................................... ' "----- Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: 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. Estimated Cost ...... ~...~.~.....-~....~..i~.. ............................... 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 .........~.~¢L~ ............................................................................ i ........ 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 some structure with alterations 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 ....~..~...(J.. ............ Depth .../....-~.....~.. .............. 10. Date of Purchase ................................................ ..~-....."~g../~.../~ Nome of Former Owner ,~...~ .............................. ~ 1 ]. Zone or use district in which premises ore situated.....~ ..................................................... 12. Does proposed construction~.~3 ~,'~ ~° '''v°°te any zoning aw, ordnance or reguaton? .......~....: ........................................ 13. Name of Owner of premise .~.~-f~..~Address ............................................ Phone NO ..................... NameN°me of of Architect ContractoJ:~..,..~~i ........ ! .............................. ........ AddressAddress i~i' ...................... ................ PhonePh°ne N O ~'.°...~.%~...~.../..~..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 NEW ~'OR,~ ,~ ~ ) _S S COUNTY OF ,.,.~ ' ................................................. being duly sworn, deposes and says that he is the applicant (Nome of individua~,~tion) above named. He is the ........... ~.~..:r.=...-.z...'z...,rm.~... .............................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hove 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 i~/i~e ~aRl~tion filed therewith. Sworn to before me this ~otary Pubtic, State 0! l~lew Yo~