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Home My WebLink About853-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located ~..l~..~..e..~.~.~..~,g...~....~..?.~.l.....~....~..~..~...~.~]~lree~e~' ......................... e,I~ ' - No *** ' ' Map Noe** Block No ......................... Lot ..................................................................... conforms substantially to the Application for Building Permit heretofore filed in this 6ffice dated ......................... ..~..e.~..e...~...l~...~....~.0..., 19..~..~., pursuant to which Building Permit No. Z ~..~. dated ................. B.~.t~lll~..~,~, ........ , 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 ....... ~k .... This certificate is issued to ...]~..~..~.~..I...~..~..t....O...l~....~.~. .......................................................... ~.;~ .... (owner, lessee or tenant) of the aforesaid building. Building Inspector 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.o 853 z Permission is hereby granted to: 1~ ~!..~t],e...~.~ ......................................... at premises located at .~..~...~.~l'.~..O.~...~...]JO.13,~fBl'~.,..~lLt, t~.~l:ill~t...l~W...~'l~ir ............ pursuant to application dated ~t,¢ '~.~/~. ;'0 19.~ , ......................................... · 9... ond approved by the Building Inspector Building I nspilector FORM l~'O. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 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 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 ar)y 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 issuonoe 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 laws, ordina~.~ an~ reg?latio, ns. ........ ........................................ . ~ ;~natu/re,ef applicant, or name, if a corporation) . '..~Xr:~ ."'~(,:I(~.../.;,:~: ...... ,,....'..-... .......... F.....~ ............................ (Address of applicant) ~ State whether applicant is owner,,I,e~,see, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ ~""~ // ~ ~* ~~~.~~ ....................................................... If applicant is a corporate, signature of duly authorized officer/' (Name and title of corporate officer) 1. Location of land on whi~J:{ proposed work w~ll be do ... Lot No: .................... Street and Number ..~....~....c~....~..~~...,~/'~..,.~ .......................................... : ......... ~ ........ C/ Municipality 2. State existing use and occupancy o~;~ises and/~tended ~se and occupancy of proposed construction: o. Existing use and occupancy....~,.._.~-r~--~,~......',~< ........ ,~... ......... : ...................................................................... b. Intended use and occupancy .....,J~......6~..;..k.~; ..... ..... ~ ~,:.~--.;; ................. : .......................................... property lines. Give street and block numbers or description according to deed, whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition ..... ~ ........ Alteration .................... Repair ~/l~Lemoval Demo tion .......... .(~.. Other Work (Describe) ........... ........ 4. Estimated Cost..i...~...~".....C~.. ...................................... Fee ..... ............................................................... (to be paid on filing this application) 5. If dwelligg;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 .............................. .... s if an Front ~ Rear ~"'¢:~' Depth 7. Dimensions or existing structure , y: .................................................................................... Height ...~...~':~:'~N. umber'/~' ' of Stories ....... ~.....'T ........... ~L, ........................................ ~ .................... Dimensions of sam~e structure with alterotio)~s or additions: Front ....... ~ ............... Rear .......... ~'? ............... Depth ................ Height ..~..'~.'..(.-~.~.~..~...').,.:~Number of Stories ....~.~.i~..¥:::~.....: ....... 8. Dimensions,,,I;:Lf e~tire~new construction:q~ront ....... ~. ................ Rear ...... ~.. ................ Depth .~.. .................. . Height ...~..~... Num,ber~" ~"-~'~ of Stories ~ ......... , ~ 9. Size of lot: ~ont'...~...."~.'.~-- ........... ; ..... Re~,~, ..... .~....~....'~.....~. ....... Depth ..../.~..O........~.. ........... .-/~ /J~,4. /~.. ~ ~ Name of Former Owner ~.~...~~~ 10. Date of Purchase 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction vLa[gte ~,~,. _ ~ Z)~ /~ any~ z~u~ing law, ,or~n~l~ce or regulation? ..~ ............................... 13. Name of Owner of premise~-~~~!'~J~~h°ne NO ..................... t ....... ~ ~, .......... ~.....Address '..~. ............... .~:Phone NO Name of Architec ............. ~,..., ............. ,~ ........ * ........ dd .....................'"'z ............. '~ .................... Name of Contractor~.'~...~.~:../.J~" '~~t~ss'~~Ph°ne NO.~..~22/ /~/ PLOT DIAGRAM Locate clearly and distinct~'g all buildings, whether existing or proposed, and indicate all set-back dimensions from and show street names and indicate this application; that all statements contc~ine~ n th s application are true to the best of his knowledge and belief; and that the work w I be performed Jn th-e n~ann~r set forth in the apj)lic~n filed therewith. Sworn to before me this ~umT~ ~', Bo ora public, State of New York ..... ~.....4......':'t~....'... aay m ,,,,-~.. ,iF.--':.~..~/,,-.~, ........... C~m,m~s~ior~ [.v.p~ ~',"/'2'- ~ ...~ , .' J) ) STATE OF NEW YORK c S ~...~ · ~ -~'L~,,,.Z~,.., ~ ,/t,,,'~x~...: ............. ................. being duly sworn, deposes and says ,hat.,~'is the appli~n, ..... i, ........ ........................................ of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file