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Home My WebLink About2090-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..]~¢~.,....~,~1&[~...}~t.3~8.~i~.8...~ ............. Street Map No. '~:::~'C~ ........ Block No ......~ ....... Lot No. ~ ......... ~OU"bh~'ic~'j'"~;'~' ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................................... ~Ttt~t ....... ti' ...... 19..~.~. pursuant to which Building Permit No...~Oc)O. da¢ed ............................... eT~n,e......'l.~...., 19...~, was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ · .P~.~a.~.. ~ne.. 'f.~'~.F '"' .~weti. irt~ .......................................................................................... The certificate is issued to "P~:'~'~'~"'"Ba'b~Ook' ......... ;"0'~'~le~ .................................................... [owner, ~essee or tenant) of the aforesa,id building. TOWN OF $OUTHOLD 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) N? 2090, Z Date ........................ Z'O,I~ ....... ~L3 ............ 19-63. Permission is hereby granted to: ........ t'uC~et~o~e.~-.....t~.'Y.,¥ ................................. t o ...... ~-u& .14...e~,..a~l~l &~.~ on.. eR.. an.- e~-].et~ ~.~.. ct.~el..1.1.~ .................................................... at premises located at ...~/t~.....~d~..l:~O~z~lt,...~l~t~ ................................................................ ........................................................ So~hoZ.~.r-..-~,.~, ..................................................................... pursuant to application doted ....................................... ~.I,11~.....~.~.....19..~.~., and approved by the Building Inspector Fee $...~..00 ............ Building ~ecto~t TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. 19...~...~. Approved ........................................ , 19....~.~...Permit No. ,Z' c~O ~' O Application No....~....O...~:..~.. ........... (Building Ins~pector) 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 drown on the diagram which is port 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 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 o Certificate of Occupancy shall hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Deportment for the issuance of o 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 cornply with all applicable laws, ordinances and regulations. ......... ..................................... (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. Loc.arian of land on which proposed work will be done. ~Map No: ............................................ Lot No: .................... Stree t a n d N umber ................. '....;~-~--~..- ~,: .... ~ .................... /~.. ,~ .,,.f.... ~.. ~ .......... ./...z ..................................................... 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 and occupancy ............ :~.&..;..~....'x~.-. ........................ 3. Nature of work (check which applicable): New Building .................. Addition / Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ (to be paid on filing this application) 5, If d~welling, number of dwelling units .............................. Number of dwelling units on each floor ........................ If gCrage, number of cars ........................................................................................................................................ 6. If Ibusiness, commercial or mixed occupancy, specify nature.and extent of each type of use ........................... 7. Dimensions of existing structures, if any: Front .......... z. ............. Rear ..... w. .................. Depth ..... /...'r....- .......... Height / ~ / Number of Stories Dimensions of same structure with alterations or additions: Front ........... ~..~.~.....~.. ........ Rear ..... ~....~. ................ Dep, th ........~...~.../. ............ Height ........... /.~. ............... Number of Stories ..../. .................................. 8. Dimensions of entire new construction: Front .......... .~.~?..z. ...........Rear ....... ~..x~....z.. ........... Depth ....~...~.~ .......... Height ......... ../..O...f .......... Number of Stories ................. ~. ............... 10, Dote of Purchase ........................................................Name of Former Owner ................................................... ]]. 7one or use district in which premises ore situated ................ ~ ..................................................................... Does proposed construction v'ol t a z ning law, ordinance o regulationP -~ ~ -- 13. ~x~a~ne of Owner or premises ~.~.~.~ ....... .~',_ ....... Address ..,!~ ................ ,' .~,.~,Z Phone ~x~o Na~ne of Architect .................................................. Address ................. .../~...~,~ ....... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lines. Give street and block numbers or description according to deed, and show street names and indic whether interior or corner lot. STATE OE NEW. Y3~J,~,,/~../~ ) ,- ,. cou ,,¥ lop ....... ~.,~.~.: .......................................... being duly sworn, deposes and says that he is the app[ic~ (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 hove performed the said work and to make and this application; that all statements contained inthis application ore true to the best of his knowledge and beli end that (he work will be perfor,~ ii~[~[~bst~s~a~l~r~ ~rk forth in the application filed therewith. Sworn to ~efore me this "' ' -'- f'~, 52.0344963, Suffolk County/C ..........r. ...... da f ....... ................................ Notary Public, .~~.,~'.../...-z2~...z...~c~..~.~c~~ (Signature of applicant)