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Home My WebLink About742-zFOI~IVf NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY Map~.CO~:[C ]Bay E~t~:k No e~ Lot No. 7[5 conforms substantially to the Application for Building Permit heretofore filed in this office dated dated .............................. ~.~.e.....~..~ ....... 19..~., 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 ................ (owne~r, lessee or tenant) of the aforesaid building. Budding Inspector HOWARD l~. TERRY FORM 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.° 742 z ~ote ............................. .~tm....~ ............ ]9.~... Permission is hereby granted to: ..l~l;~....~/C. · ·. 2, aY.. J~a~a ............................. ........ Br~ea]~rd~r...l.~.. ....................................... to .. I~1.. aa. ~,t4~. ~. ~. ~ st~. ~wo;l~ ........................................................................ at premises located at ..~t,..~.,~r..~o,%'~.c..~,~..~.~f,~. ................................................................... ................................................. .!~... ~.~.r~ ..~.~1 ,....~r~.~r.t, ............................................................ pursuant to application dated ............................. .J..~......~.. ................... 19..~.~...., and approved by the Building Inspector Fee $..¢j.~..0~. .............. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. .......... ....... Di~ro e~ ~/c .................... .~.~ ............................................... ............ APPLICATION FOR BUILDING PERMIT Dote ...... ( .~-2-~'~ J~ ~ ~c~ i NSTRUCTIONS 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 o detailed description of layout of property must be drown on the diagram which is part of this location. c. The work coYered 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 purpose whatever until o Certificate of Occupancy shall hove 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 oil applicable lows, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applican~~nt, architect, engineer, general contractor, electrician, plumber or builder.; / / If opplicnnt is o corporate, signature of duly authorized offi e~ (Name and title of corporate officer) 1. Location of land on which proposed work will be done. Map No: ~..~.....~.~..~..~.}.......~...?..~...~. ..... Lot No: ....Z...~... ....... Street and Number ......... fi: ..................... .~..;.'.~;~.~:;.: .; ............................................. Municipality 2. 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 .......................~.t ................ [~......~...~.:.~ ........................................................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair ............... ,.,..Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ~. ~ ~ ~ Fee (to be paid on filing this application) 5. If dwelling, number of dwelling umts ................................ 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 Rear Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ....... /.....~. ........... Rear .......... ./.....~[. .......... Depth ..~....~.. ................ Height ............................ Number of Stories ..... ~ ....... 9. Size of lot: Front ........~...9. ........... Rear ....... ..~......~. ............ Depth ...../..?..~ .......... 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or use district in which premises are situated ............................... .~ ....... '~i"Y'i'~ ............................. 12, Does proposed construction vi~late any zoning law, ordinance or regulation? ................................................... 13. Name of Owner of premises.~..~.~ ........ Address :.~.~..;~...~.~.~..~.~: .......... ....... e NO ..................... Name of Architect ........... ..~...C......~.i'"~v ~ ~ . ...... Address ............................................ Phone NO ..................... Name of Contractor ....... .~..~ ........... ~....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. (Nome o' individ.., signing ap "co .J .X,. above named He is the ........................... ~..'../. ....... ........................................................................ .... (Contractor, agent, Corporate officer, etc.) of ~id owner or ownem, and is duty authorized to ~fform ~;~ave performed the said work and to make and file this applicatlon; that all statements contained in this applic~W~ ate true to the ~st of his ~l~ge and belief; and that t~ work will be performed in the ~nner s~t fo~h in the applicat~n filed therewith. / ~ Sworn to ~fore ~ this ~ ~~ ~~ ........... d of .............. .... ' ~~ Notn~ Public, S~tt ~ New ~o~