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Home My WebLink About956-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CEJt. TIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at 'L~'~8"'"~Z*o'h~,~'"~;'t ............................. Street Map No ......................... Block No ......................... Lot No ................. 0~.~.~: ....... ~T.,.~'~, ................. conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... eTe.)lt~e,~,.~ ....... .~., 19.~G., pursuont to which Building Permit No...~..~).~(~......: ..... dated ............................... ~1~a~.......~9...~O wae issued, and conforms to all of the requirements of the applicable provisions of the law. The occupa, ncy for which this certificate is issued is ................ ..................... ~.~.~.r.,~,e,...o~e.. £ ~ ~..*L~'...d~.~!Z.'tz~ ............................................................................ This certificate is issued to ...~,~...~....R~k~'~'~ ........ (~,~1~'.~ ..................................................... (ow~e.r, lessee or tenant) of the aforesaid building. ¥ ' Building lnspecttr FOI~M 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? 956 Z Permission is hereby granted to: to BUtlg an adc~tton On at premises located ot pursuant to application dated ~ ~ 19 ~ , ............................................ ~ ......................... and opproved by the Buildin~ Inspector Fee $~.00 ' FO~M NO. 1 TOWN OF $OUTHOLD ~UILDING~DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. Application No .......'./....'~......~.. ......... APPLICATION FOR B~J~LDING P[RMIT Date..... /'~..~..~.~.~.:&....../....~.~: ........................... 19..~.r.;".. ~.~..'.. INSTRUCTIONS o. This opplication must be completely filled in by typewriter or in ink and submitted in duplicote to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to odjoining premises or public stree;~s or areas, and giving a detailed description of Iayout 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. At~PLICATION 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 alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applic.able laws, ordinances and regulations. ........... .................................. (Signat~le of applicant, or name, if a corporation) .... ........ ............................... ............ (Address of appli~nt) State wheth,er 9pplicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber, or:budder. ............... .................................................... ~ ~ ,/~ ~-~" , ' c~ L~' ~ .~ t~ ~c. ~2'~.~ ................................................................. Name of owner of prem ses ...... L.,.....: ...... k ........ /...: .......... ~ ............ .~:.~.....- If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) I. Location of land on which proposed work will be done. Map No: ........... f.....~ .......................... Lot No: .................... Street and Number .......................................................................... ~..~ ............................ - .............. Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use a d occ p y ............ ~'....:;.-.;;.' . ~.;r ............................................................................................... ~1.1,~_~' b. Intended use and occupancy · 3. Nature of work (check which applicable): New Building .................... Addition .................... Alteration .................... Repair .............. wwRemoval .................... Demolition .................... Other Work (Describe) .................... Estim,~te,~ r-ost /~//~L) O ,- 4. ~ u ,~ .~.. ........................................................ bee .......................................................................................... (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 nature and extent of each type of use .............................. 7. Dimensions of existing structures, if any: Front...'.~.~.~..;..~'..;.~ ....... Rear ............................ Depth .M..?. .................... Height .... ?Z../'[..~ ............. Number of Stories ........... ./....~.,~ ........................................................................................ Dimensions af same structure with alterations or additions: Front ....~...: ...... ~.:: .............. Rear ...{. .... ~ ................ ~-/t / Depth ...~..~...i'..~..~..( ........ Height ........ ~. .................... Number of Stories ......... ~,, ................... 8. Dimensions of entire new construction: Front ....... Height ...... ! ............... ; ..... Number of Stories ....~..../. ................... 9. Size of lot: Front ..U..I......" ...........Rear ...~.../........c: ............ Depth ................ ..~... ......... 10, Dote of Purchase ........................................................ Name of Former Owner ..~..:.~.~.~....~.~..~? ........ 11. Zone or use district in which premises are situated ................................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~...~.Z .................................... 13. Name of Owner o p m s.u~s.,..~..~--.~/.~ddress .......... ~........~..,.;f.~..Phone NO ..................... Name 2~;~'.~. of Architect ...... i" ........................... '~ .......... Address ............................................ Phone NO ..................... Name of Contractor ..... .~../.4~.....Address ......~.....-/~..~.../~.....~..,..Phone NOO../~.2-////z'/ .................... 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 inferior or corner lot. / ~/ ~/ () ~ > STATE OF NEW~h'Oi~J~,, ,9/~, ) ¢ ~ COUNTY OF ..~~:...) ," '~' ............... ~.~__;~/~..g~.~ ........................... being duly sworn, deposes and says that he is the applicant (Name~f individual sig~g 9~lication) 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 appl/cotmn; that all statements contained m th~s apphcot~on ore true to the best o h~s knowledge and belief; and that the work will be performed in the manner set forth in the application filed therewith. Sworn to beJore me this _ /~ ' f ~' 19 ~ U (Signature of applicant) ........................ aay o ....................... , ............................