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Home My WebLink About2206-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No..~..~.9.~0. ........... Date ......................... O~t~,~e~'......].~....., 19~..~... THIS CERTIFIES thor the building located at .~/~.....~O~..t~...~g~ ................................. Street Mop No....~ ......... Block No .....~ ...........Lot No ......~ ....... ~.~O~.¢I...~.,.~., ............. conforms substantially to the Application for Building Permit heretofore filed in this office dated ................................. ~ ......... ~ .............. , 19.~.. pursuant to which Building Permit No....~0~..~ doted ............................ 00~.......~ ........... , 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 ........ .... ~-~.. ~o...~t.ly'..~l.~,tn~ ....................................................................................................... The certificate is issued to ..... ~oh.~..lit~.a~$[~ ............................... ~ ..................................... (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) N? 220§, Z Date ................... Permission is hereby granted to: .~.h~ .,F.,,,.]~icap±t e. ........................................ ........ $o~.t h.--l~e~d. ............................................... .............. O-~een~-t ............................................. to ,~- 1.1~ -. ~n...ac~8 .~.t len.. ~n,..a~ ..,:~.~.~t-~.n§, ,- d. we.t.~..~ng. ........................................................ ot premises located at ..... ~'/'~..'.-1~O~F'~"~a(]' ................................................................................... ......................................... G~. ~e~po~.t ~:. ,L..I, ................................................................................... pursuant to application dated ............................. ~)o~b~r.......3 ........... 19..~.3., and approved by the Building Inspector Fee $'-'~',rOO' .......... Building Inspector ~j~ TOWN OF SOUTHOLD BUILDING DEPARTMENT ~ TOWN CLERK'S OFFICE SOUTHOLD, N. [xamined ~ 19 Approved ........................................ , 19 ........ Permit No..,:...., ......................... ~ ............... "~ .... ~'~'~'ffdin0 In~po~or) [ ............................. '". '~ APPLICATION FOR g~ILDI~G PERMIT Application No.....~..' .~.....O.....~.. ...... a. This application must be completely filled in by typewriter or ~n 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 af 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 Bailding InsRector will issue a Building Permit to the applicant. Such permit shall be kept on the. premisqs available for inspe,~ti0n thro6ghout tfie:~rogress of the work. e. No building shall be occuPied 6r used in whole or in pa rt for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Dep~r~'ment for the is.suance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, SuffolklCounty, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions or: o Iterations, or for. removal or demolition,,as herein described. The applicant agrees to comply with all applicable laws, o~dinanc?s and reg'ulations. (S'~ture of applicant, or name,,~4~a corporation) . . , '~ (Address of applicant) State whether applicant is owner, lessee, agent, architec¥/engineeb ~§enerd contractor, electrician, plumber or builder. ....................... ............ : ......................................................... : ......................................................................... Name of owner of premises .......... ,,.~.:- ...................................................................... If apphcant ~s a corporate,~,dg'~nature of duly authocjzed officer.... ~.~"- .... (Name and title of corporate officer) ? ....... '~.~, q ~ ' 1. Location of land on which proposed work will be done. Map No: ............................................ Lot No: .................... Street and Number "~'"~'"~'"~'~'~'"7 ....... ~..-~.-..~.,......~..~~......~..t.,~...~ ..................... Municipality 2. State existing use and occupancy of premises and intended use and occupaflcy of proposed construction: o. Existing use and occupency .. ~ .~o'~ .~...~..~..'~') .~.a~t.....~ ......... .' ........................................ b. Intended use and occupancy ............................................... ............................................................................... ',~ Date ..................................................... 19 ................ INSTRUCTIONS 3. Nature of work (check which applicable): New 'Building .................. Addition ....... Alteration ............. Repair .................. ~r~,moval .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost .......... .~.....6~.....1~..~...~ ........................ Fee ..................................................................................... (to be paid on~filing this application) 5. If d~velling, number of dwelling units .......... .~. ................. Number of dwelling units on each floor ......... /'.. ............ If g~rage, number of cars ................................. :.'~.. .................................................................................................... 6. If I~usiness, commercial or mixed' occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front....~.C~.L,~...i~ ....... Rear ....../...~..~...¢~...'.'. ..... Depth ....~....~....~..?'...~.~... Height ....... ~.~...~. .......... Number of Stories .............'.~.'...~-.' ................................................................................... Dimensions of same structure with alterations or additions: Front ..... ..~..O..~...4~....~ ....... Rear ../.~.../.....?..~ ...... De~th .....~.'....~...J....~...i~.... Height ...... /...~,. ,.I.. ............... NL~mber of Stories ............ ./. ......................... 8. Dimensions of entire new construction: Front ....... ./'..~..../...~'....~ ....... Rear ..../..~...~...~.....~i .... Depth ......~....../. ........... Height ....~..~.~ ............... Number of Stories ........... /. .................... 9. Size of lot: Front ...... L~...C..r..'.~.....~. ...... Rear~.~il,.~..~.. ............. Depth ....~....'.~.../...~..,~....?.. ............ 10. Date of Purchase ...... ~......~../..~....~....-~.....Name of Former Owner ~...~.....~., ......... 11. Zone oruse distric~n whichf'/premises are situated ........ ~ ................................ ../.. ................ 12. Do~s proposed construction violate any zon_ing law, ordinance or regulation? ........... ..~.....<~.. .............................. 13. Name of Owner of premises~...~.~.'...~..~¢~ddress..~...~.~...~..../.?...../~/.?..4~..~...~.../~e 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-back dimensions property lines. Give street and block numbers or description according to deed, and show street names and indic~ whether inYerior or corner lot. CO~TY iOf;,~..~;/~C....~..~ ' ' ., ~ . ,..~--..:.-.~.~~.t~,...........: ...... be,rig duly sworD, deposes and soys thor he is the opphc( /// (Name of individu~cation) abog"e named. He is the .................................................................................................................................................... ' (C, ontrac~or, ag~ht, corporate officer etc.) of said ortner or owners, and is duly authorized to perform.,qFrhavS' p'Sff6~rried the said work and to make and this appliqation; that all statements contained in this'appliea~r¢,on are ~true to the best of his knowledge and bell and that t,he work will be performed in th~,, manng¢ %~1' fortH'i~ the application filed therewith. Sworn to before me this .......... ..... da, ' ,,, '~:t i 'o8 t ........................ ........................ : ................................ Notc~ y~l~~ ........... ~..~e,. ~/,,~.~1~ ~y ~;~'J ........... .iS ,g n at.~i~.~.~.)... _