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Home My WebLink About2264-zFOIP~WI i'~O. 4 ,~ TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTNOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ....... }j//~,.....~]~.~.~...~e~d .............................. Street Map No ..... ;J~ .......... Block No ......... ~ ....... Lot No...~..q~ ........ .O.?...~..~.~.t...~.t.~.? ........................ conforms substantially to the Application for Building Permit heretofore filed in this office dated ..................................... D.e~,.,......(~ ............ , 19.~.~... pursuant to which Building Permit No. dated ................................ J)ee.~.....6 ....... , 19.~.3.., 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 ........ ...... ~.~..~.a~e....one...£~L:~r...d.~m Y..~ ~ ........................................................................................... The certificate is issued to .......]-~/~,~l~'.~.....~O:J,~t~, ................................................... O~e~. .................. (owner, lessee or tenant) of the aforesaid building. · Building Inspe~t~" " FOKM NO. ~ 'TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y.. BUILDING PERMIT (THIS PERMIT MUST B[:,K~P'I~ ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Pe. rmission is hereby granted to: ...... ~e~.,.J~o~,~..~? ...... ~; .................................. .............. · .er~e~ ........................ ; ...... : ............... ~. to ....... ]~.~ .:~l..~ev., e~i~o~..ez~...a~t ..e~i~i~.. ~t~m~ .:..,-.. ......................................... ............... ~ ................................ ~ .............. ;. ............................................. ; .................................................... at premises located at ...... J//~l~..JJ~a~ ....................... ~ ............... ', ........................................ ~ ........... : ..... ................. ~ .................. ~ ................... : ....... ~l~.~t...N~.~.~ ............................................ ~ .................... :... pursuant to ~pplicatlon dated ....................... :...~)~...t~..~ .... 19.~:~.., and approved by the Buildingr InsPector Fee S.~. .................. FOR. M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFF]CE SOUTHOLD, N. Y. Examined ........... ~.....Crt.. ...... ~...., 19...~..~. Application No Disapproved a/c .............. ;:~ .,~..j~7~~~~_..~_~_,. (Building tnsl~ctor) APPLICATION FOR BUILDING PERMIT Date .............. D.eoe~er.....6 ............... , ~9.6~ ........... 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 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. Henry Moisa (Signature of applicant, or name, if a corporation) ................ .Orient .................................................................. (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builde}. owner - Contraetor 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: ....~ ........ Street and Number .....J~.:J,.~...~g.~¢.! ........ .0.~..~.~.~.~. .................................................................................................... Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ....... dW~ ......................................................................................................... " with an additio~ b. Intended use and occupancy ................................................................................................................................. 3. Nature of work (check which applicable): New Building .................. AdditLon ....... ~. Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost .......... ~O0..~./M ................................. Fee ...~. (to be paid on filing this application) 5. If dwelling, number of dwelling units .............. ~ne ........ 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 ............. 28 ........ 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 ...... ~1, ....................... Rear ......... .~. ................ Depth ......... ]..I,~ ......... Height ............................ Number of Stories ......~ .................... 9. SiT? of lot: Front ................................ Rear ............................ Depth ......................................... 10. Date of Purchase ........................................................ Name of Former Owner 11. Zor~e or use district in which premises are situated ........ tlA. II..~ 12. Does proposed construction violate any zoning law, ordinance or regulation? ............. ~Q 13. Name of Owner of premises .~e~'...~.Ba ............ Address ............................................ Phone 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 fr property lines. Give street and block numbers or description according to deed, and show street names and whether interior or corner lot. STATE OF NEW YORK, ) COUNTY OF S.l~.O~k ............ ) S.S. ................................. ,~.~.~.....,~)J,,~& .................................. being duly sworn, deposes and says that he is the appHo (Name of individual signing application) above na~ed. He is the ............ ~e~...-...~d~ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the sdid w6rk and to make and this application; that aH statements contained in this application are true to the best of his knowledge and be[ and that the work will be performed in the manne~bt ~¢t~ in the application ~/led therewith. ' Sworn to before me th s ; , ~ . . ~ -- comm~u t xp~.2arch 30, i~ / / --" .................. ~.... aay o~.~ ....... ~~ ........ , ........ , I ~ .... Nota~ Pu?ic,