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Home My WebLink About1122-zFOR~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF' OCCUPANCY THIS CERTIFIES that the building located al ROCky Point Rd., EaSt ...................................................................... Street Map No ....................... Block No ....................~ot No .............................................................................. conforms substantially to the Application for Bnilding Permit heretofore filed in this office ~ne 23 60 ~ 1122 19 ........ pursuant to ~vhich Building Pe~i~ No. dated ..........' ..................................... ' ....................... ~ne 27 19...~, was issued, and conforms ~o all of the requirements qated ............... .................................. , of the applicable provisions of the law. The occupancy for which this certificate is issued is This certificale is iss~o ....~.~.P8...~.~.,...~K ......................................................... (owner, lessee or tenant) of the aforesaid building. Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. ¥. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE pREMISES UNTIL FULL cOMPLETION OF THE WORK ,~UTHORIZED) at premises located at /"/.\C_/i,: ~/ !'~'L) ' r,, t /c ,~ .~ 2, ...................................................... ~: ........ ~ ....................... ~, ......... ' .............................. ; ........................ t .... pursuant to app ~at on dated .......... ~.~.:-. ....... ~, .........~..:L~....Li ...... 19..,r~:...',0 and approved by the Building Inspector Building Inspector FOEM NO. 1 TO~VN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ~...~.g..r,.~.'...~., 19 c~ o Approved .... .~..~...~.¢........~....~,., 19...~...'¢..Permit No ................... ~.~ Disapproved a/c ...................................................................... ...................... ~B~ilding Inspector) Application No. //~ ~ ' APPLICATION FOR. BUILDING Date..~......~'_ ..-ff.. ....................... , ........ INSTRUCTIONS o. 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 shal~ be kept on the premises avo.i~able 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. ,Ihd,'~ ~ ............... APPLICATION IS HEREBY MADE to the Building Department for the issua.nce 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. ............. .............................. (Si,¢qature o,¢'applicc~, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Nome of owner oF premises...~~'"..~~ .................................................................. If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location oF land on which p,,qropose~d work will be done. Map No: ..................................... : ...... Lot No: .................... Street and Number .............. *. ................................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ........ ~..~,~. .............................................................................................. b. Intended use end occupancy ......... ~~..~.....~,~.. ............................................................................................. 3. Nature of work (check which applicable): New Building .................... Addition ...... ..~'..:Jii~.....Alteration .................... Repair .................... Rer~j~qval .................... Demoliti'on .............. ~... Other Work (Describe) .................... 4. st mated Cos .~./~ e (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 ........./(,~/....z. ....... Rear ..... ./....~..(./.../. ......... Depth ...... .~...~,q-,-.~ .............. Dimensions of same structure with aJteratlons or additions: Front ......... v~..~.~.'..;:. ........ Rear ...... /....~...~...~.. ............ Depth ........ Z~...:. .............. Height .......... ./..~..... .......... Number of Stories ................................ 8. Dimensions of entire new construction: Front ...... ,~F-,)..../. .......... Rear ...... .~....~......./. ....... Depth ...~..~...../. ............. 10. Date of Purchase ......................... .................Name aF Former Owner .... [..C.;....L..'..c~ .................. 11. Zone or use district in which premises are situated ............. .?~..? ............................................................................... ' 12. Does proposed construction violate any zoning law, ordinance or regulation? ....... ~ .................................... Name of Architect .......................................... Phone NO ..................... .................................................... Address 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 NEW 'O .,Z MS S couNT ' ' .............-- '~' '~ ..~.~'~n..~../.(~' ''~ ~..'. ............................................... being duly sworn, deposes and says that he is the applicanl '(Na~e of ~dJvJdual signin~.~...~applicati°n) , above named. He is the ............... C..~.~...; ........................................................................................................... (Contractor, agent, corporate, officer, etc.) of said owner or owners, and is duly authorized to perform or hav.e 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 Jn the man~rr~ ~ Jn the application filed therewith. ~r~ Pubhc, State of New York .......... ~¢.~ay of '"v'"';~"~;~ 19..(~..P.. '