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Home My WebLink About1010-zFOR~ NOo 4 TOW~ OF SOUTI'IOLD I~UiLDING DEPARTMENT TOWN CLERK'S OFFICE SOUTI'~OLD, IN'. ¥. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located al m .~i~[~..KO'ii*..~~ ...... Street ~..O.~....B...~.~.....I~ fr~ ...... ~.~. ~. ....... Lot No ........... 7.7... &.. ¥/1~ ................................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ............... I~1~k.25 ........... 19.tilD.. pursuant to which Building Permit No ........ ~lated ............... l~i&l~cl~.-~t$ ............. 19..f~0, w.as issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ P.R~3li~Clg..0~E...PI~IILM.. B~l~I~I~l~IgO ................................................................ This certificale is issued to .........~t~l:oJ,~[..~tli~%~l:.,...o~rrt~l:. ....................................................... (owner, lessee or tenant) of the aforesaid building. FOI~ NO. ~ TOWN OF SOUTHOLD I~UILD~NG 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) 1010 Z Date ......................... ,~J0~....~ .......... t9....$0 Permission is hereby granted to: .. ~.o.3,.~...8..¢.~.~.~ .e. ~ ......................................... Ea~: will~t~n, New at premises located at p~'.$,~'at,~...r.o~.~,...;~t~..,~,o~,...~ ~ ........................................ ................................... l,o.t..s...,~,,...9. 7...&...78,... ~a.~..~a~".. ~:t,~. ....................... ; i ..... pursuant to application dated ................................. ~..~...~. ........... 19.....~.LO, and approved by the Building Inspector I spe tar FORM NO. 1 TOWN OF SOUTHOLD BUiLDInG DEPART,VtENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Disapproved a/c ..... ~.~~.~ ..................... ~.... ............ (Building Inspector) Application No...../....~..~... .................. 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 ava.liable 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 HERESY 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 al appl cable laws, ordinances and regulations. ...... ................................. (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises.../.~.~.?.......~~ ............................................................................... if applicant is a corporate, signature of duly authorized officer. (Name and title of corporate, officer) . .~...c. _~..~...~...,.~.. ~ .?~..~ .?,.. ,~', 1. Location of land on which proposed work will be done. Map No: ..... No: .. Street and Number .. ~ ....... e .......................... ~.f..~'..~...~'.'.~ .................... Municipality State existing use and occupancy of,l?remises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...~~1 ............................................................................................... b Intended use and occupancy .......... ~'..~. ...... ~..~..~.....~....~..~ .............................. t ' Locate clearly end distinctly all property lines. Give street and block whether interior or corner lot. 3. Nature of work (check which applicable): New Building .................... Addition........~'. ........... Alteration .................... Repair .................... Removal .................... Demolition ....... ~, .......... Other Work (Describe) .................... 4. Estimated Cost ....]...(:!...~..?. .......................................... Fee ..'..~... .......................................................................... i ........ (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 .............. '~....%72. ...... Rear ............ .,~...,.~5;,, ....... Depth ....... .~......'a~.. ................ Height ............................ Number of Stories .............~ ................................................................................ Dimensions of same structure with alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ................................ Number of Stories ................................ 8. Dimeneions of entire new construction: Front ....... /.,.,'TJ'. ............... Rear ........ ./...,~,. ............. Depth ~' ~ Height ............................ Number of Stories ....... ~ ........... 9. Size of let: Front ....... .~....,'~,. ............ Rear .......... '.2...5 ........... Depth ,_,!..~.,..O, ................ 10. Date of Purchase ........................................................ Name of Former Owner ....................................................... 1 1. Zone or use district in which premises are situated ............... ..~,. .'. ....................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ~ ....................................... ]3. Name of Owner of premises.~L`~..9`~?....`~.~.~`~)?.~;~Address~!~..~:`~.~.~.'rt~...~'...~.`.~(~ne NO ..................... Name of Architect .................................................... Address .......................................... Phone NO ..................... Name of Contractor .................................................... Address .......................................... Phone NO ..................... PLOT DIAGRAM buildings, whether existing or proposed, and indicate all set-back dimensions from numbers or description according to deed, and show street names and indicate P//7 STATE OF NE~q~YqR, K_/~f _) S S COUNTY OF .~/~t/~...u~...)~; ~, . ................... ...... ~,.:~7. ~..:~&...:-~ .............. ~,v.,r.~ ....................... ~m~ duly ~wom, (Name of individual sign[n9 applicotioa) above named. He is the ............. (~.~(.~:~, .................................................................................................................... (Contractor, agent, corpora~ etc.) of said owner or owners, and is duly authorized to perform or have ~rfor~ the sai~ work and to make and file this application; that all statements contained in this application are trueffo)~ best/of his knowledge and belief; and that the work will be performed i%~ ~F set forth in the appli~/~ fi~ed~effewith. Sworn to beforeme this ,'"' ~?:~.t~s:¢, su~rou~ t~¢amtx , ~l ~,, If ~11 ........................ day of .............. ~:.....;.~ ............ _~ ' I'