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Home My WebLink About1292-zF~)R~ 1~0. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWI~ CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ~/...~...~q.~.~;.~...~"~.~...I~.~... Map No. ~ Block No. *~ Lot No. conforms ~ubstantially to the Application for Building Permit heretofore filed in this office dated ............. ~.~..~ .............. xg.~.~., pursuant to which Building Permit No...~..~.~.. dated ........... ~.~...~ ............... 19..~.~., was issued, and conforms to all of the require- merits of the applicable provisions of the law. The occupancy for which this certificate is This certificate is issued fo ...~.,__~.,...~;.~_..~.~ ............................................................ (owner, lessee or tenant) of the aforesaid building. TOWN OF $OUTHOLD BUiLDiNG DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y~ BUILDIt4G PERMIT (THIS PERMIT MUST BE KEPT ON THE PRE~i~ES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) ' Z Date .................... ~T~p~:.-"3 .............. 19..6t. Permission is hereby granted to: fl. Ho~te'~ ." · 'A/e · ' 'M~ ~2 yR.-an ......... ,. .................... ........ ~o~hotd ........................... ~ ................... ;.~:. to ... B¥-t. td... a.n .. ~d a.t.~.~..on-.on...an...e~:s.~:ng...dwe']...~: ~.t~g ...................................................... pursuant to application dated ...................... .o~ttl, l....~. ......... :~ ............... 19..~.}, and c~pproYed by the' Building Inspector Fee $..,.~'-i'00 .......... FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~':~..!'~Z .'~...~. ........ Approved ........................................ 19 ........ Permit No. Disapproved a/c ........... ......... [... (Building Insl:*ector) Application No. / ')'*¢C('~ ~'~' APPLICATION FOR BUILDING PERMIT Oa,e ............ ........................... ..... 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 Jot 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 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 Deportment 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. 'l/~-~ ~ L (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) 1. Location of land on which proposed work will be done. Map No: ..... .~.'......~. ............................. Lot No: i.~.'..~k ........... Street and Number ..~../~. ....... ..~..'.7~.,~,,,~:~,.'.,....~%~.'.¢.~,~: ............ ~:.?.~?.~.~..!.¥/?..~../..~· ......................... :.::~.'.i] ............. Municipality 2. State existing use and occupancy ofrxpr, emises and intended use and occupancy of proposed construction: ,J),f)0,~, ))' , a. Existing use and occupancy ......... .~. :N~ · ~'k', .% .~. :h';'. · j · ,. :. ....... ','"'~/t ............................................................... ' ............... o. mrenaea use aha c p y .......................................... : ..................................................................................... 3. Nature of work (check which applicable): New Building .................... Addition .....~,.i.'~........Alteratlon .................... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................... 4. Estimated Cost ......... .0..c.? ........................................ Fee .......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling un,ts ................................ 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 ....... .f..z?~_ .............. Depth Height ............................ Number of Stories 9. Size of lot: Front ...... j...0....~ .......... Rear .......... ~.,...~.. ......... Depth ...... ~.~.(.~..".~q/.~..~.. · 10. Date of Purchase ...... .~?. ................................ Name of Former Owner ... ~..',,~;,:... ~ ................ Zone ar d str ct which rem ses ore s tuated ........ ................................................................. 12. Does proposed construction violate any zoning Iow, ordinance or regulation? ....... /~..O. .................................... 13. Name of Owner of premises.....~...l'~..:.'~-,~.....!.~,.'~.~,,"~....~,...Address ............................................ Phone NO ..................... Name of Architect ........................................................ Address ........................................... .;~ Phone NO ..................... ~/~- ,' ~ ,-~-e;~,~ ! ~/ Ph NO ..................... Name of Contractor ..... :~,....g~..'~...-~,.:- .............. Address ....... ~c. ................................. one 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 numb or descriptjon, accocr~_ing to deed and show street names and indicate whether interior or corner lot. STATE OF NE'~M YO, RJ~,./~/j.,~) S S COUNTY OF '~[~ t) ~ ~.(Q) ' , (Name of individual signing appli~tign) above named· He is the .............. ~z ............................................................................................................................ (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 know[edge and belief; and that the work will be performed n the man~er set forth in the application filed therewith. ~UD TH T. BOKEN Sworn to before me this ~ ~ot~ry Pt~Jc, state at ~ew York ...... .~.. day of .~.~ ...... ~.~s,~,/~?,r~rch 30, ],~t~"