The URL can be used to link to this page

Home My WebLink About1097-zF,O~I~M~ NfO. 4 TOWN OF SOUTHOLD BU~'LD~'NG DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y, C~.RT].FICATE OF OCCUPANCY THIS CERTIFIES that the building located agl/lt..Leet~a'l..Dziv~,....SOll~Ollt,..lq~ltY~et Map No ....................... Block No ..................... Lot No ............................................................................... conforms substantially to the Appli~tion for Building Permit heretofore filed in this office ~ ~ ~9..~ pursuant to which Building Permit No. · ~09~ dated ..... , ........................................ , ........................ ~lated .............. ~U~...~ ................ , 19.~.0.., was issued, and conforms to all of the requirements of the applicable previsions of the law. The occupancy for which this certificate is issued is ~A~ O~ F~ILY ~ (S~R COTTAO~) This certificate is issued to ~.~..~...~....0~ ...................................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector FORUM 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) Fee $'5~.'00"~-.~- ~.~d N? 1097, Z Permission is hereby granted to: ,Be .1.1a*~r e.. 2'/~... Ne~ .. ~o~.k- ............................. pursuant to application dated ................................. ~..~ .............. ;,19,J60 and approved by the Building Inspector : ~ 'Building Inspector : ' : 'I ' TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved ........... ~..~....¥.~.;,..¥~..~,.... 19....~...C.~pe rmit No ...... ~., .~...(.~.~..?.. Disapproved a/c .......................... ..-~.-.~ ...................... ~ (Building Inspector) Application N o. -~....~..~.../,~ .......... 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 o 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 Bdilding Department for the issuanae of a Building Permit pdrsuant to the Building Zone Ordinance of the Town of Southold, Suffolk Coun}y, 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 har~/, if a corporation) J r ¢ ., /'.~ddre~s of applicant) ~/1 j .U' State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber br builder. ............................... ....................................................................................................................................... Name of owner of ~i .... ~,.J ! ,..-Cc-~ ~ . :.~'. ~:~ ...................................................................... If applicant is a corporate, signature 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 · M ~ ~ i~'i.~'~ii.t'~... '.7 ...................................................................... ~NumDer ................... ; ............ ': ........... ;' ............. 2. State existing use and occupancy of pr. emises and intended use and occupancy of proposed construction: a. Existing use and occupancy ..................................................................................................................................... b. Intended use and occupancy 3. Nature of work (check which applicable): New Building .................... Add t on ................... Alteration .................... Repair .............. :zr. Removal .................... Demolition .................... Other Work (Describe) ....................' 4. Estimated Cost.....1....../....OZ~....~..P...O.~ ................................. Fee ............. ...~..~...~ ............................................................. (to be paid on filing this application) If dwelling, number of dwelling units ............. [ .................. Number of dwelling units on each floor ........ / .................. 5. 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......~....%'C....~., ....... Rear ...~...'~z.......~..,.... Depth ....~.~..'..*~.....~..~ .... Height ............................ Number of Stories ..... it ...................................................................................................... Depth '-~"~./~././~ Height Number of Star es , 8. Dimensions of entire new constraction: Front...~.~...~T., ...... Rear ...... ~.~..~..,.. Depth ....~...~..~ ...... Height ....~)....~...~ ......... Number of Stories ..... L.....~ ............... 9. Size of lot: Fron% ...... ~.0..~., ..... ~ar ....~.0~.~ ....... Depth .....~..~...~' 10. Date of Purchase ................ .{._.-~.~..~ ................ ~.~ome of Former Owner ...~ ....... &.,...~.~....~.,...~.O..t ............ 1 ]. Z~ne or uso district in which premises ~re situated ........... ~ ................................................................................ 12. Does ~roposed construction violote onv ~onin~ low~ ordinonce or reOu~tionP .... 13. Nome of Owner of premises~~, ~A .. ddress Name o¢ Architect' ........................................................ ~' ' -- Address ............................................ Phone NO. .................... Name o~ Controctor ............. ~ ...................................... Address ............................................ Phone NO ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate oil set-back dimensions from property tines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STA'FE OF NEW//YC~,i~K,cZ .~ ) S S COUNTY OFx~.~..q~f......) ' --~/Z~z.~'' .~z~ ~~ be no du v sworn, de oses and says that he s the app cant (Nome of individual ~"~lication) above named. He is the ................/~~ .................................................................................................................... (Contractor, agent, cor~orate 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 in the manner set f~ ~ h~pplication filed therewith. Sworn to before me th~s ~.%~?r~e, s~at. of ~ew vor~ ~/ ~ll~ 'U344963, Suffork Coun[y , ~)~ Hn~z nf ~~ .... ]~ ?~..~r~ ~arch $fl tn(/ (Signature of apphc~nt) .......................... '-" .............. - ' Nota~ Pub[i · ..~oun y~Q