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Home My WebLink About573-zNO. 4 TOWN OF SOUTHOLD EUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the. building located at ..:~,,~J~..~C~t~,~,...~:L~.~.~,:~,~,..~:,.~.~ ...... Street Map No. ~ww Block No .........................Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ~e~ 2 19...~ pursu.a'nt to which Building Permit No. D February ~ 59 doted ...................................................... 19 ......... wu~ issued, u~d com~or~s to o(l o~ the o~ t~e o~Jcable provi$ioos o~ the Jaw. l~e occupuucy ~or w~Jzh this certificate is issued Js ................ Thi~ certificate is }ssue~ to ..................................................................................................................... (owner, lessee or of the aforesaid building. · 0~ NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. BUILDING PERMIT fi'HIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N.° 573 Z Permission is hereb~nted to: .... ~_.....~.~..~...' ....... Y ................ Building Inspector BUILDING DEP~RT~NT TOWN CLERK'S OFFICE SOUTHOLD, ,. Y. Examined.....~ ....... ~ ........ 19~.~... Approved ........................................ 19 ........ Permit No ............................... Disapproved a/c ......~.~ ............. ~..~ Application No. ~' /~ ~ APPLICATION FO~ BUILDING P[RMIT / Date ..................... .~... ...... .2~ ...................... 19~.... 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 port 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 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 whale 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 Deportment 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. (Signature of opp icant, or name, if ~.~drporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. , .......... ............................................. Name of owner of prem'ses .......... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Location of land on which proposed work will be done. Map No: ............................................Lot No: .................... Street and Number .......... ,..~...~.....-~.....,/...~. ,../. ....... ¢-.~.~,,~.,../(/~.. .............. ....~..~:~)..,(../.,, .~--/~...~,.,~-'./..~. ...... ..~..d..:~:.~, ....... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. E×,st,ng use ond occupancy ............... ....... ....... ...... b. Intended use and occupancy ............................ .~,,/~.4~,~ .............................................. ./.; ........................... ,! _,.~,,~uu~e~: New Building .................... Addition .............. Aiteratton .................... ~epoir .................... Removal .................... 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 ........................... "......; .............. .................................................................. .2 ........................ ,~. 6, If business, commercial or mixed occupancy, specify nature and extent of each type of 7. Dimensions of existing structures, if any: Front ........... ~...~.. ....... Rear ...... ~..~. .............. Depth ........ .~...~ ........... Height ............................ Number of Stories ..... .~.., ............................................................................................... Dimensions af same structure with alterations or additions: Front ................................ Rear ................................ Depth .............................. Height .............................. Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~,...~.. ............ Rear .........~....q~.. ............ Depth .......~..~, ........... Height ............................ Number of Stories ...... ~ ................ 9. Size of lot: Front ............................. Rear ............................ Depth ............................ 12. Does proposed construction violate any zonln~ I~w, ordinance or regulation? .............. Name of Architect ........................................................ Address ................................... , ........ Phone NO ..................... Name of Contractor .................................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate oil set-bock 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 NEV~ Y~J~J,t, ) $ S ....... ) · - ~"~/~"~("/"~"~--~¢~ivid ~~J~ .............. being duly sworn, deposes and says that he is the applicant · g g above named. He is the ....................................................... ~ .................................................................................. (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or hage performed the said work and to make and file this application; that ail statements contained in this application are true to the best of his knowledge and belief; and that the work w be performed in the manner set ~or~h in the application filed therewith. ~ Sworn to before me this ~:~ ~.~¥~,~?"'? ~ ~ ~ / ~