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Home My WebLink About2127-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ...... ~...~.~5,1, ........ Dote ................ THIS CERTIFIES that the building located at ......... ~d~y..~Ve,.,...~,:t.tU~t¢ .......... Street Mop No ..... .~.45 ........... Block No ......~ ......... Lot No .......]BO~C.~.&~..O:~...26.,.2.?.,.2~ ................ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................. J~1.~...24 ............... , 19-63. pursuant to which Building Permit No. Z...2~2~1.. dated ........................ ~..u~.~...25.~...~, 19..¢.'.~., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ .................................... ~urr~..ze,~&de~ce ....................................................................................... The certificate is issued to ...... (owner, lessee or tenant) of the aforesaid building. ..... Building InspeCtor FOI~I NO. 2 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 2127' Z Dote ................... ~....a~ ................... ~3 .... Permission is hereby granted to: l~lelae'~ ..~ .e..rt..~.......~..~..... ]~e.i~ Icte.. l~ezl~,.y .......... .Z..~ .,?,.. ~ ~s~.. ~,c~ ............................................ ...~.e...o.!~, ...~.,.~:... ............................................... to .B...~...~....n...e.~...o. rie... ~.aatl~..cl-,~e,l. tt.~ag. ...................................................................................... at premises located at ...~.e. L1 .~.eoo&....I~...hat~...to~s...a6~i...a?.~...aa ....................................... .............................................. l~eta~...&~.e,.....~Iai~l.~ ............................................................... pursuont to opplicotion dated ............................. ~lt~......~{L.~, ........1~,.,~ ...... , ond approved by the Building Inspector Building Inspector- ' FOI~M NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE i~ .,~.. SOUTHOLD, N. Y. Examined ......... ~ ....... , 19 Approved ........................................ , 19....]..Permit No. Z~ i ~ ] Disapproved a/c ,/'J ~~ ~~ ~ ................... ........................................ (Building Insl~ector) APPLICATION FOR BUILDING PERMIT Dote ............................................ , 19 ........... 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 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 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 pa rt for any purpose whatever until a Certificate of Occupancy shall have been gr.o:nted 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 Lows, 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 oil applicable laws, ordinances and regulations. ............... ......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. If applicant is a corporate, signature of duly authorized officer. (Nome and title of corporate officer) 1. Location of land on which proposed work will,be done. Mop No: .............. ?...~...~.. .................... Street and Number .......... .~...~'.. ......................................... ,.~..,x ...................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed,eonstrucho~n: a. Existing use and occupancy ~ b. Intended use ond occuponcy ...................... 3. Nature of work (check which applicable): New Building ....... ~ ....... Addition .................. Alteration .............. Rep, air .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ..........~.~..~.¢.~R..~ ................................... Fee ...................................................................................... (to be paid on filing this application) 5. If d'welling, number of dwelling units ................ ./. ............ Number of dwelling units on each floor ........ ,/. ............. If garage, number of cars ........................................................................................................................................ 6. If business, commercial or mixed occupancy, specify natureond extent of each type of use ............ ~ ............ 7. Dimensions of existing structures, if any: Front .......................... Rear -- Depth .......... ?7 ............. 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 ......... ..~...¢..../.... Height ........... ~. .............. Number of Stories ................. Z ............... 1 I. Zone or use district in wmcn premises are situated ............................................................................................ 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ..'~.¢. ............................... Name of Architect .................... .%. ............................... Address ........................................... Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr property lines. Give street and block numbers or description according to deed, and show street names and indic whether in'terior or corner lot. STATE O8 NEW YORK, ) COUNTY OF ..8.~J~.¢~[( ........ ) S.S. RIC~ ~. ~NARY ................................................................................................. bein9 duly sworn, deposes and soys'that he is the applicc (Name of individual signing application) above named. Ne is the .................¢.~&~.q~ ............................................................................................................ '. (Contractor, agent, corporate officer, etc.) of said uw'ner or o,¢ners, and is duly authorized to perform or have performed the said work and to make and this application; that all statements contained in this application are true to the best of his knowledge and bel and that the work wJJ[ be performed in the manner set forth in the application filed therewith. ................ , ...... ..... ' ..... ........................ Notary Pu~I,c,U.M~.-.-%E~ .%_~.~A~5 ~O County"