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Home My WebLink About1627-zFOI~M ~O. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. of the oforesa'id building. /~.~ ~~ CERTIFICATE OF OCCUPANCY o ............................. u~....~... .............. ~(~-~~¢"J'~%'":'~ ...... ; ........... , 19 ........ TrNJIS CERTIFIES t at the bu,lding located at ............... ...... ~~ ........ ~. .... Street ~",~.~,v (~'~-~, J m,.,, ,.,il Map No ....................... Block No .......?~... ............. Lot No....~...¢ .......... .~..~.J..~~.~.~ ..... conforn~s substantially ~the Application for Building Permit heretofore filed in this office dated ............................... ~...~......./.....~.. ...... , 19..~...!.. pursuant to which Building Permit No. ~./,...~....~. dated ........................ .¢~......./'....~.!....., 19 ......... was issued, and conforms to all of the requirements of thj~pp]icable provisions of the law The occupancy ~for which this certificate is issued is ........ ..... ~~ ........ ~..~~~..~'~ ,~ -~, ........................................ The certificate is issued to ~ ~~~..%~ ......................................... ~ '"i;:,'~;-;;;,:.;' i;;;;;;;,' ';:; ;' '&'~)' ............................ .... ........ .................... Building i'r~l~'~:~ ~'" '[ 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) 1627, Z Pe~by granted to: , pursuant to application dated ........................... ~f,.._.].....~ .......... 19...~..(, and approved by the Building Inspector Building Inspector FOI~M NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. l.~'.....~....~.. .......... Disapproved a~......~ ................................................ iiiiiiZiiZ??i'iiii iiiiii ........................ (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 application. 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 pa rt for any purpose whatever until a Certificate of Occupancy shall hove 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. ..... :J. ....... ......................... (Signature of applicant, or name, if a corporation) (Address of applicant) State whether applicant i~s owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ..... ...~....~.~ ........... 6~ ................................................ '. ...................... If applicant Js a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which propos dwork wi' done Map No' ~ (~ Lot No' O~ Street and Number ...... ~'......~~i ................ ~'~ .................... ~, Municipality ........................... 2. State existing use and occupancy of premises and intended~nd occupancy of proposed construction: a Ex st ng use and occupancy ..... .~... ?..~....~...~ ........... ~.~.~ ................................................................... 3. Nature of work (check which applicable): New Building .......... (..~..... Addition .................. Alteration .................. Repair .................... Removal Defnolition .................... Other Work (Describe) ........................ / 4. Estimated Cost ..... ~....~../.....~..~'....= ........................... 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 ......... ..~....?. .............. Rear ....... ..~....?. ............. Depth ..._~....O..../...../...~.=...~ Height ............................ Number of Stories .......~.~ ........ Size of lot' Front /. ~ ~' Rear Zz-~ ~' ~ .. Depth /' 0r~:~///~.~.'..~.. 10. ~ Ofr P~rcha,s9. : ii'"'i" i'i'[;[. ii'i ~' ' "~,'~i! ~ ',. ~iiii~ . iiiiiii~'~ ~I~~Z~ i°~f Fo~;"iiii ~ ....... iii~/..~t~..[ .......... 11. e o use d's 'c w 'c p ....../...~ ..................................................................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ ~ .................................. 13. Name of Owner of premises ........................................ Address ............................................ Phone No ..................... Name 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-bock dimensions from property lines. Give street and block numbers or description according to deed, and show street names and indicate whether interior or comer lot. ~ [ ~ X ~ ~__ STATE OF NEW/~'O]~K COUNTY OF ........ ) S.S. ................ ..~.../~~'. ................................. being duly sworn, deposes and says that he is the applicant ~lame of individuaVig~n.~appli_~ion) above named. He is the ...... ~?.~ ..................................................................................................................... (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 in the manner set forth in the application filed therewith. Sworn to before me this '* JUDAH T BOKEN .............. · /..7..:.~ day of ............ · / ...... , ........................................................ Notary Public, ~f~-~-~.~'~~ ' (Signature of applicant)