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Home My WebLink About752-zFORM NO. 4 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the, building located at ..~.'?.:~.'...J~.9.~.,".,L.~(./.~...;~...[!?..:.Z...,O..~?..~..e~l;eet Map No ...... ~?.~? ............. Block No. ~!~, Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~Tt~Ly 6 19..~Q, pursu,ant to which Building Fermit INo .......... ; ................ dated .............................. ~]~..~. ..........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 ................ ................................................... ~Z~:,~L..OL~[~.. 2 ~ . L~:C ~!~ Z~ ............................................. This certificate is issued to ~l~p ~e~ (owner, les~ or tenqnt) of the aforesaid' building. / Building Inspector NO. ~ TOWN OF SOUTHOLD BUILDING DEP~MENT TOWN CLERK'~I mICE SOUTHOLD,~,Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 752' Z Date ................................ :~...u~.....,~ ........... ] 9...~?,. Permission is hereby granted to: .~..~y. ....................................................... .............. ~../..s.......~..~ ............................................ ........................ ~,~..~....~:~.?. .............................. to ]~...ild aa ad~iti~a en an existing 4well~g~ at premises Iocoted ~t ....~.~..~f~ ...... ~.~..~....~.~.n.£...~.~ .......................................................................... ... .~'~,~.~.~,~ ~.~.I.., pursuant ;to application dated ................................ ~I'IL~ ........ III ............. 19..~.,, and opproved by the Building Inspector Fee $ ........................ FOI{I~I NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved ............ ~,...~.. 19....~...Permit No ........ ...~......~...,~... ~ Disapproved ale .......~. ..... ........... :~:....2'.i.~.........., ................... ~ ................ ~ ............. ...... (Buildlnfi Inspector) ~ APPLICATION FOR BUILDING PERMIT Application No ..........~...~...~..c~... .... INSTRUCTIONS This application must be completely filled in by typewriter or in ink and su~omitted 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 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 whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuanc,e 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 taws, ordinances and regulations. (Address of applican~ff' State wheth,er applicant is owne~tect, engineer, general contractor, electrician, p umber or builder. ,, Name of owner of premises ....... ~.~.~......~~/z. ~ ',_ ............................................................................ If applicant is a corporate, signature of duly authon'zed of "f'r(ser. .. (Name and title of corporate officer) 1. Location of land on which propose~LwoLwill, ~-~//~ ~x.~/-~ ~ ~/~be do. ne. Map No:, ........................................... Lot No: ...~ ........... Street and Number, ...~./~....:~..~....~`~./.~:~(~i~`~.~;~.~¢~.~.~...~. ..~... 2. State existing use and occupancy of pr,emises~and intended use apm~ occupancy ,of proposed construction: o. Existing use and occupancy .................. ~~..~~ ............... ~....~ ........... b. Intended use and occupancy ...................... ../..~.. ................................. ./....c. .............. Z~..~..~.~ ...... ~~ 3. Nature of work (check which applicable): New Building .................... Addition .......... ~AlteratJon ....... ~ .... Repair .................... R~oval .................... Demolition ............... >,~:Other Work (Describe) .................... 4. Estimated 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 n~a~:~/~nd extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front .............. ~.c.,~7~... Rear ........... ~:~.~ Depth ....... ~ .......... Helght .............. ~ ......... Number of Stories ......... ~ ................................................................................................. Dimensions of sa~ne structure with alterations or additions: Front ........ ~.......~'.Z. ....... 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 ..., ....... .q.~.~.~. ...... Depth ....~..~ ...... Date of Purchase ........................................................ Name of Former ,gwner ........................................................ 10. Zone or use district in which premises are situated ..................... ~....'.Z/~...."~..~ ............................ 11. Does proposed construction vio~ny z, onin~ Jaw, ordinance or~ji~ulat!on?,. ...... T.¥,~..4-~... .............................. 13.12'Name of Owner of premises,..~.~.Address ....~....~......Phone NO ..................... Name of Architect _..,;z.jj~..~..-. ·~.-. -~? ...... ./. ...... Address ...................... ; .................... Phone NO ..................... Name of Contractor ....... .~..~.~dress ...... ~ .......... 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 NEW YJ~'RK~,,~. ,~ S S COUNTY OF ..~ ' ...................................... ~~....~ ...... being duly sworn, deposes and says that he is the applicant (Name of indi~dual sigr~flg application,,f) above named. He is the ............. ~ .................................................................................................................. (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 al 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 t~9 ~i~filed therewith. Sworn to before ~e this ~ ~:~ c~/ ~ ~, ~f . ..~. 19 ~o ~'os~Z~'~' ~ign~ure or, pi.cant) .............. ...... ....