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Home My WebLink About981-zFORM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No. J~ 684 Date ~llle ~'4 19.~...0.... THIS CERTIFIES that the building located at ...~.~..~......j~.....~z......~...~.".~.....j....~.....j~...?..~..~'.!...`.~.t..~..°~treet Map No ......................... Bilk No ......................... Lot No ................................................................... conforms substantially to the A~lication for Building Permit heretofore filed in this office dated ........................... ~.~..~.~.., 19.~..., purs~nt to which Building Permit No ....... ~...~ ........ dated ......................... ~.~.~..~... 19..~., was issued, and conforms to all of the requirements of the applicable provisions of the law. The ~cupancy for which this certificate is issued is ................ of the aforesaid, building. Building Inspector 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? 981, Z Date ........................ ~'~fl~,t~.... ~:~. ........... 19.~... Permission is hereby granted to: · -~oph..~h ................................................... ~.~, ..A,~.., ......... to ..... ~ld.. ne~.. :~[~. ~ui~ ................................................................................................ at premises located at ....E/~..~ .~.~;~:~et~.~..~B~y,..V.i~..~l .......................................................... ................................................... ~o~I~1~....~,~ ......................................... pursuant to application dated ........................... .~.eB~r....~O .............. 19..'~0.., and approved by the Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. E×om,ned ........ 19 ........ Permit No. Approved tL *' ' ' ,. ~..'~.~'.~: ......... D sopproved o/c ~' .......... ~:~ ........... ya~ ............ ¢C~ .............. ~ ........... /i ........... ~ (Buildin~ Inspector) Application No. ' - ........ ;~..~..Z~ ............ APPLICATION FOR BUILDING PERMIT Date ......... ~X..,,I') t 0 , 19.~...O.. 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 o Building Permit to the applicant. Such permit shall be kept on the premises available for inspe,ction 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 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 comp y with a appl cable ows, ord nonces and regu at ans. (Signature of applicant, or name, Jfa corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. ........................................ of : ....... i';/'~",;: ~;' ~"; i'.;' .............. . ............... ~ff~ .............................................................................. Name of owner ............................................................................................ (~ h ff If applicant is a corporate, signature of duly aut orized o 'icer. (Name and title of corporate, officer) 1. Location of land on which proposed work will be done. Map No: ..... ,../:.....7..~. ............................ Lot No' jk. ~ Street and Number ....c.?,./.~ ......... 2~2Z~.~.,.~....r~,¢~.~.. .............. .~_/2L.d~¢...,~/';~?;y.,f.~./.~, ....... ~.,,.,~...., ................ Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ '~,,¢,.a,¢c.,,:.;'.,k;.. ...... %,/...~:.~..,:...; .............................................................. b. Intended use and occupancy ............ ,a~z.~.~,,.~..~,,~.......~.~.d.~.,:.....;; .~..--.~.~ ....................................................... 3. Nature of work (check which applicable): New Building ...... ~ .......... Addition .................... Alteration Repair ............. ~,.... Removal .................... Demolition ........ ,~ .......... Other Work (Describe) ~lC...,. ~ '¥- ~ .................... · 00 -,-..J. 0 4. Eshmated Cost ..I..~.+.~ .............................................. 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 ............................................................................................................................................ ._~._._._.7_._.._ 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 ................................ Height ............................ Number of Stories ............................................................................................................. Dimensions of same structure with aKerations or additions: Front ................................ Rear ................................ Depth ................................ Height ............................... Number of Stories ................................ 8. Dimensions of entire new construction: Front .......... ~.~ ............. Rear ......... Z..~ ............. Depth ...~.~ ................. Height ............................ Number of Stories ...... ~ ....... 10. u e ............................ Name rme w . L....;t ....'..~ . ::..;~.....'.. 11. Zone or use district in which premises are s~tuated' ................ ~-~ ................................................................................. 12. Does proposed construction violate any zoninp~ law, ordinance or regulation? ........................................................ 13. Name of Owner of prem~ses..~:~,z~,L, ................. &ddress ..A~v ................ ~ .............. Phone NO ..................... ' ' (; ~:' '""~ Address ' ....... ~ .... ~' Nome of Architect ......................................... ...... fd ............ ................... Phone NO ..................... Name of Contractor .................................................... Address .......................................... Phone NO ..................... 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 interior or corner lot. STATE OF NEv_.~z2~&s.z~L~vxc ) S S COUNTY OF ~ff~.~.:::h.....) ' ' ................................... ~...J ........... ~ ...................... ~....] ........... being duly sworn, deposes and says that he is the applicant (Name of ind~uol signing opp~ation) above named. He is the .......................... ~7~..' ................................................................................................... (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 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 n th~ manner ........................ aay~ot ................................. .~¢t~d~:~.,,.t~;~',~,g~i~ Gcun+5 .~~ (Signature of app cant) Notary Public, I pc. --7 C > 4~ 0 .e.'q C I< 2_ / ::/ //f ,/' :/