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Home My WebLink About975-zFOR~ NO. 4 TOWN OF SOUTHOLD BU~ILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ......... ~...6,7.C~ .... Date ............................... 0~'~,~ .. ~5. ........ , 19...~.0.. THIS CERTIFIES that the building located at ..~tJ~..,~.,~r~.~...~.~,~...~D.~.~3,g,~.~. Street Mop No...~.~t. .............. Block No ....... .e~t.~. .......... Lot No ........................... f~.~ ................................. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................... ti'~.tl~.~...l,~.,,, 19~i..0..., pursue'hr to which Building Permit No ....... ~.,.~,~.,~o ........ doted ................. ;P.~b~,~...2,0 .......... 19..~.0., we~s issued, and conforms to all of the requirements of the applicable provisions of the Iow. The occupancy for which this certificate is issued Js ................ ............................................................. ~ ;L~...r)~,~.. ~. ,~k~ ~'.. ~.~;.~;L~. ..................................... This certificate is issued to ....~;~;,.>~t,~t~.¥t~,~'.,....~.~. ............................................................. (owner, lessee or tenant) of the aforesaid building. Building Inspector FOl~i~I 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°. 975 Z Permission is hereby granted to: ~e~' ~ F~.o.~.,..t.~,~....~..~r.~...~.y. ................... S~u%he~d ~ N~X. at premises located at .~.~. ~ ..~.~.e..~..~.~. · Southol~, :NoY, . pursuant to a~-.ca-.onnnli tl dated ............................................ , ................ ........, and approved by the Building Inspector Fee $..~.:..0.~ ............... Building Inspector d FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUT,OLD. N. ¥. Examined .................... " 7---9 7.5 .... Approved ...................................... :.19 ........ Permit No ........................ Disoppraved c/c ......... (Building Inspedor)[ Application No ...... ~....7...~...~.. ........ APPLICATION FOP. BUILDING PERMIT Dote ......... .................................. .... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and su~omitted 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 ~ 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 alterations, or for removal or demolitlon, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. 2 ( (Signature of applicant, or nome, ir a corporotionj ....... ....................... (Address of applicant} State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .............. ............................................................................................................................................ Name of owner of premise~-~'...~..~...~.~. ...... h .~../~....~.~ ......................................................................................... If applicant is a corporate, signature of duly authorized officer. 1. koc*tion o{ land on which proposed work will be done. Mop Mo: ............................................ Lot ~o: .................... Street and Number .~..~.~P-....~.~.~ ........ ~,~ ..................~9~.r~.~...~..'~¢ ............................ Municipality 2. State existing use and occupancy of p~emises and intended use and occupancy of proposed construction: a. Existing use and accupcncy ...... ~ ...... ~.~ ................................................................. b. Intended use and occupancy ................................................................................................................................ 3. Nature of work (check which applicable): New Building .................... Addition .....~......Alteration .................... Repair ........ '. ........... Removal ............... :....Demolition .................... Other Work (Describe) .................... 4. Estimated t (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 exter~t of each type of use .............................. 7. Dimensions of existing structures, if any: Front ........ ~.~ ............ Rear ....~%.~. .............. Depth ..~.~ .................. Dimensions'of same structure with a[te~tions or additions: Front ..~.......~ .................. ReaF ................................ Depth .............. :~ .............. Height .............................. Number of Stories ................................ 8. Dimensions of entire new constrvction: Froqt ............................Rear ............................ Depth ............................ Height Number of Stories ............................ 10. Date of Purchase ...................... ........................... ....... Name of Former O~ner .~.~.~.....~.~ ........................ ~ 11. Zone or use district in which premises are situated .......... ~~.~ ................................................ 12. Does proposed construction violate any 'zoning law, ordinance or regulation? ..... ~ ........ '......: .............. N~me of Architect ........... ................................... ,...L....Address ............................................ Phone NO ..................... P~OT DIAGRAM Locate clearly and distinctly all buildings, whether existing .o[ propCsed, and iadicate all set-back dimensions from property Hnes. Give street and block numbers or description according to deed; ~nd show street names and indicate whether interior or corner lot. ' STATE OF NEW~O~, /Z ) S S ~/~~~<~ ~' '~" be n- duly sworn, deposes and says that he ,s the applicant (Name of individual signing a'pplication) (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authgr~zed tq perform o( hqv~ ~Fformed the said work and to make ~nd file this application; that all statements contained i~' thi~ a~plication are true to the best of his knowledge and belief; and that the work w be performed in the manner set fort.h io the apRlication filed therewith., Sworn to before me ,this . '