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Home My WebLink About1238-zFOEiV~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLEBK'S OFFICE SOUTHOLD, N, Y. CERTIFICATE OF' OCCUPANCY THIS CERTIFIES that the building located af .$ot~th.. Dmtv. e ......................................... ,. Street conforms substantially to the Application for Building Permit heretofore filed in this ioffice 19..60 pursuant to which Building Permit No..~,..~,~]~...,.. dated dated ................... Qe.tclbe;~...~l,~...., 19.60.., was issued, and conforms to all of the requigements of the applicable provisions of the law. The occupancy for which this certificate is issued is ..... l~.iV, at.e...one .. ~.ar~i. Ly...dwe.! ling .................................................................................................... This certificate is issued to ..t{Obe~'.l;...(~Ol~Oll. .......................... Ot~le.~ .................................. i ............ (owner, lessee or tenant) of the aforesaid building. ..... Building inspector FORM NO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS FERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 1238 Z to Permission is hereby granted to: ,, ,.~ ~ .... ................................. ~..~ ~ .............. pursuant to application dated .................... (~.?....~:'.~ ......... ~.~.. ........ 19.,~..?and approved by t[~e Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OP~:ICE SOUTHOLD, N. Y. ......... Approved ...................... : ................. 19.....:..Permit No ............................... Disopproved o/c .......... ~..~... ..................... i~ ui ld'i'~'~ ...... 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 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 alteratlons, or for removal or demolition, as herein described. The applicant agrees to comply with all applic.able laws, ordinances and regulations. ......... ......... ~ress of applicant~ State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premise .. ~ ...... D .......................................................................................... 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 .... ?.. ...,'ffQ~.. .~. .................................. Municipality 2. State existing use and occupancy of pr,emises an~ intended use and occupancy 0f proposed construction: o. [xistin~ use *nd occupancy ............ ~ ........................................................................................... b. Intended use ond occup~nc~ ..................................................................................................... /10. 11. 12:. 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 occul~cy~ -',,,x,,.,~.s~e(if~'~oture and exterior, of_ each type,o,f, use .............................. 7. Dimensions of existing structures, if any: Front ................ : ...........Rear...i ........................ Depth ............................ Height Dimensions of same structure with alterations or additions: Front ........................... .....qz-R'ear ................................ Depth .............................. Height .............................. Numl:~f Sto~e ,~.... ............................. Dimensions of entire new construction: Front ...... <~..~ .~..__, Redtr .~..~..../. .............. Depth ....,~-,.~...../. ............ Height ........ /..~..¢ ............. Number of Stories ...... ...\/.. .............. Size of lot: Front ........./..O....~.. ........... Rear .......... (..¢...~ .......... Depth ..../...~../.~ .............. -,. ~ Date of Purchase .............. ~t..~./..~.~.~). .................... Name ~F_or~e~ ~..~/~..L...?.~.c.C..~....!...~....S.~ ..................... Zone or use district in which premises are situated ........... f,~cq~~.......~......~...m .................................... Does proposed construction violate any zoning law, ordinance or regulation? ........... ~ .................................. Name of Owner of premises...~.~..:.~.~.~ .~.. ............... Address !.'Z.~..~...~.../.~..r.f...~...~./.,~..~..Phone NO..~...~..~..o..~..3 Name of Architect ........,~ ................... ~, ...... ./. .............. Address .......................................... Phone NO ..................... Nome of Controctor.~'r/..~,...~...~ ...... Address ..,Z.~r.~,...~.~ ...... Phone NO..~,~..-:'..~.~..~.~,:a,7 PLOT DIAGRAM Locate clearly and distinctly oil buildings, whether existing or proposed, and indicate all 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. S o o T~ IJr ~f lr~ ~ '~ ~ l v (,~'~ ~ ~ STATE: OF NEW YORK , ') S S. ~- ~ t~L' ben~. ...~.~.~ ........... ~~ .................................. u duly sworn, deposes and says that he is the applicant above .am(eNc~mHee~[ Zt ividual .............................................................................................................................. .signing a~z . (Contractor, agent, corporate officer, etc.) of saki owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all 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 forty, in the application flied therewith. , f · ~o~ ~,ulr~ r Sworn to be ore me th~s "o ~ ~,~/,~, ~ - ~;¢~ ~ .... · ~ ~