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Home My WebLink About805-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPART/~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the buildln.g located at .~./.~...~,~..~,.O~)~..~s.~..~'~.~.~t~Street Map No. ~ Block No. ~*~ Lot No.l~.~. .................................... ......................... conforms substantially to the Application for Building Permit heretofore filed in this.,office dated ...................... A~J~I~t~&..3.3 .............. 19.~,~l.., pursuant to which Building Permit No. ,,~..L~..O...~. ............ dated /t,l~tt~ ].~. 19 I~.~.. wa,s issued, and conforms to all of th~ requirements of the applicable provisions of the law. The occupa.ncy for which this certificate is issued is ................ ..................... P,]~I~ATE.. O!~1E.. F~J~,ILY..Dt/EZ~L/~ .................. ~i:~ ..................... This certificate is issued to ...D...s,..V...~..~....~:._~.~.e.,~...~.,,....~..~h~,f~.~.l...O.~t~ ........ L?.; ...................... (owner, lessee or tenaJ4}} of the aforesaid building. ~, i ........... ............. V...L:%..~,, .............. ~... ' Building lnspecto,~ L~, ~ FOI~M NO. 2 TOWb~ OF $OOTHOLD 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? 805, Z Date ....................... ~a~a~... ,']~. ............. 19~ ..... Permission is hereby granted to: ~.,avi&..~. t.'taz:i e l ..,Tw~f.£ ............................................... ......... ~'~in..~d ......................................................... ..................... .g.~l~.g~ ~....~.~ ........................... to ..... baild ..new..~ .. f~5~ily..~w~]./£~ ............................................................................................ at premises located at .E/S....,'faff!o~z'..~o,e~ ..................................................................................... ............................................... ~fa ~f.~.k.~. · · · ~ ~.Y .......................................................................... pursuant to application dated ........................... Aagua2 ......I~ ............... 19~;.~...., and approved by the Building Inspector Fee $.],Q,.QQ ............. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......... ~,~. 1 9..~ .~.. Approved ....... ~.~.~...,9~.Permit No......~...~.~......~... ..... Disapproved a/c ................................ ~.~;.~ ...... ~ ............................. . J .............................. ................................... '"'L ......... (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 adioining 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 o~cupied 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 a Iterations, or for removal or demolition, as herein described. The applicant agrees to comply with oil applicable laws, ordinances and regulations. ...... ....... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ......................... ................................................................................................................................................. Name of owner of premises.....~....'44/../Z../.~.......~.....~'~.r'x'~....4~..fff....~'../..~...~.......~- .~.'.........~...~...~/.~F'/..~.....~...~..~. ................. 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. Map No: ............................................ Lot No: ./.....~... ........ Street and Number ..ii ........ ...~..~...Y.......~../.0./4~.~.~......~....°...~../-~.. .......... ~.'~.....~...~'..../..~..'.~..C¢~... ....... ../~...;.~.., ..... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ......... ,~. ...... 4~...~.../.4,~,.~.~...~. ....... ..~.....0....'~... ............................................................... b. Intended use and occupancy ......... .~....,.../~...0'..~...k~........~...o....../..o'....~........~....~...(~.....~....~..../...~....x.~. ........................ 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ................................ Number of dwelling units on each floor ............................ 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use .............................. 7. Dimensions of existing structures, Jf 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 ......... .~ ............... 11. Zone or use district in which premises-- are situated ....... ~Z..~.~~ ............................. ~ ................ 12. Does proposed construction violate any zoning law, ordinance or regulationP ....... ~ ........ 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 NE~Y~,~. ) S S , ....................................................... ; ..................... ~.~ .............. being duly sworn, deposes and soys that he is the applicant (Nome of individual signing applicati~h) the ~ ............ 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 ~st of his knowledge and belief; and that the work will be performed in the manner set forth in the opplicati~ filed~.~ Sworn to before me this ~