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Home My WebLink About1704-zFOi~.~I NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATe OF OCCUPANCY TH IS CERTI Fl ES that the building located at .e/..~.:J.O~..J~V~,.,..J~,t,4i,~;._~ ...... Street Map No ...?...~.?. ............ Block No ......~...~..~.. .......... Lot No ........... ~ ................................................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ............................ ...~..~,.2,..,.?,:.....~..3. ............... 19.....6...2 pursuant to which Building Permit No ....... ~...1,.7..04 of the applicable provisions of the law The occupancy for which this certificate is issued is ......... .......................................... ..................................................... This certificate is issued to .... ..~..-...J~..~JI.~.L..~.~.*~.~...~. ................................................................. (owner, lessee or tenant) of the aforesaid building Building Inspector/ 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) N9 170~' Z Permission is hereby granted to' co~.~Z~...~.~..~. ~r ............................................... at premises located at ..~, ..]~;[g. Ol~...~.~.O ...................................................................................... pursuant to application dated ..................... ,J~]~.~. ...... ~r' ............. 19~ .., and approved by the Building Inspector Fee ............. TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ..................... ~.....~ ............. , 19..[*.?.Permit No...~...../..2..?.....~.. Disapproved a/c ......... ~.'. ............ ~ ............~ ............................. Application No..../....~...D....c:~. ....... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This opplication,~ust be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing !ocotion of lot and of buildings on premises, relationship to adjoining premises or public streets or areas, and giving a det~i!ed description of layout of property must be drown on the diagram which is part of this application. c. The work covere~ iby this application may not be commenced before issuance of Building Permit. d. Upon approvaI oR !this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept o4 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 have been grante~,: by the Building Inspector. APPLICATION IS FI~REBY 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 ef buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees t~ comp y w th a I applicable laws, ordinances and regulations. (Signature of applicant, or name, if o corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signatU[e of duly authorized officer. (Name and t!tle of corlSarate officer) 1. Location of land ~n which proposed work will be done. Map No: ..... lot No: tmunlcipolity 2.State existing use and occupancy of premises and intended use and occupancy o~ pr0posed construction: a. £xisting use and occupancy .,.....!r~.....rt~sJ.1j~.j~ ..................................................... f'..}, ........ ) ............................... 3. Nature of work (check which applicable): New Building .................. Addition ....~l;~l~ ...... Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..... ~i.ID~I~[II~ ................................... 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 sams structure with alterations or additions: Front ................................ Rear ................................ Depth ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front.....~l,6 ...................... Rear ................. ~...~. ...... Depth ......... .~...~.. ............. Height ............................ Number of Stories...O%~ ........................ 9. Size of lot: Front ........ .~0 ................... Rear ............... ~..0.. ........ Depth ......... ~..~....~. .............. 10. Date of Purchase ........................................................ Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ...... ~'~....d.~.S.t, ....................................................................... 12. Does proposed cOnstruction violate any zoning law, ordinance or regulation? .............. !~ ................................... 13. Name of Owner of:premiSes ..... I~.....~:~,%1,I~I...~.~' ........... Address ............................................ Phone No ..................... Name of Architect. .............................. ..~. .................... Address ............................................ Phone No ..................... Name of Contractor ..... ~.~...~.~..%'.....~....~.,...~.~]~.Address ....... ...~...t,..~.~.~t~...~. ............... 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 YORK,. ) COUNTY OF ....... ~.1%~'~t~1~....) S.S. .................... ~.. ~.~(.~ ................................. being du~y sworn, deposes and so~ that he is the applicant (Name of individual signing application) 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 wo~k and to make and file this application; that all statements contained in this application are true to the best of Els know'ledge and belief; and that the work will b~ performed in ~e ~,~ ~r~in the application filed therewi~. Sworn to before me this ~ot~ ~u][~