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Home My WebLink About1058-zI~OI~M I¢{). 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT 'I:OWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY TH~S CERTIFIES that the building located at ..~......~..~..R~.~.4 ...................... Street Map No ...... ~ ............. Block No ..... ~ .............. Lot No.~ ...~.~J;ho~ ........................................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .......................... ~,.~:~.l~.....~, 19....(~ pursuant to which Building Permit No....~.~.Q.~.~ ..... dated ........................... ..A~.~.~......2..~, 19......~..,0was issued, and conforms to all of the require- ments of lhe applicable provisions of the law. The occupancy for which this certificate is issued is .~[14.~],J~;~t?~ .............................................................................................................................. This certificate is issued to ...~T,...~,...I&~J.~.. ............ .0.I,¢~,~: .................................................. (owner, lessee m' tenant) of the aforesaid building. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MU~T BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 1058 z Permission is hereby granted to: at premises located at ..~/$.....tf,~ln...~J.J~..-.-; ......................................................... M?!...' ...................... ....................................................... ¢~t~o:l,/L~.....~.,~ ....................................... ~,/.?.~: .................. pursuant to oppl,cot,on dated ............................... ~....Z~ ........... 1~.0..,, ~[appro~d by the Building Inspector }r~''~: ~ Fee $.~: ....... ........... Building / \ FORM NO. ! Approved .................................... , TOWN 0~: SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,, > 1¢) ........ Permit No ................................. Application No...l....~...~'...?... ........... (Building Inspector) 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 o 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 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 applicable 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. Nome of owner of premlses...~,,r:../. ................................. Z~'~O~..~...-..=I. ............................................................................... ( / / If applicant is a corporate, si~grr6ture 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 ...... ~ ......... : ....................................................... Municipality State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............................................................................................. b. Intended use and occupancy ..................... t.~ ............. ~.....~..~,..~.......~.K~.J.~.~.~~ .............. Repair .................... Removal .................... Demolition ........ ~ ......... Other Work (Describe) .................... 4. Estimated Cost ..... ~>0 aa ~- 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 ............ ~.....~ .......................................................................................................... 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 alterations or additions: Front ................................ Rear ................................ Depth ................................ Height ............................... Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ~L...~/ ............... Rear ....... .~.....~ .............. Depth .....?~...P.. ................ Height ............................ Number of Stories ......~ ....... 9. Size of lot: Front ....... ~...O. .............. Rear .......... ~i~T...g .......... Depth .......gz:...0~..b.. .......... 10. Date of Purchase .. ./. Z .~...~.. ... Name of Former Owner ...~.~....~.~....~¢V(.,//~..~ 12. Does proposed construction violate any zonina law, ordinance or regulation? .......... ..~...0.. ...................................... 13. Name of Owner of premises..~.../...c~.......~... ........ Address ......... ~.~...~.Z...~. ....... Phone NO ..................... Nome of Architect .................................................... Address .......................................... 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 NEWY(~EtK ,') ) ¢ S ........................ ~[~..~? .......... '...~ ............ [ ............. beinO duly sworn, deposes ~nd soys thor he is the ~pplic~nt (Name ~' i~id~l ~gning application) ~ . above named. He is the .............................. ~..T......~~: ................................................................ (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 ail 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 forth in the application filed therewith. SWam to before me this ~1~11~, ~ate of ~ ~ ......................... ~ .................. ~ .................................. ..~ ~r¢fl ~.~ - ~