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Home My WebLink About2003-zFORi~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTN~ENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ...Fa/.~...~.~.Q~.D...]~.~ .............................. Street Map No. XXX Block No. XY-,Z, Lot ~o :XX Cut;ehogue~ ~T,Y, conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... ~[a3~.O. tL....~,~. ........ , 19~3.... pursuant to which Building Permit No. ~,,O.Q~ ..... dated ............................ ~..8:..~.~,,h......~.8......, 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 ........ ........... .................................................................................... The certificate is issued to ....~[fL~.~.~,.~.l~.g~.~.O.l~ ................... .~.~.e.~ .............................................. (owner, lessee or tenant) of the aforesa,id building. FORM NO. 2 TOWIq 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? 2003 Z Date ................................. M~-r~...18 ..... 19~3 .... Permission is hereby granted to: Stz~hsn Road at premises located at ..~/S..S~,~...C~e.~..~ ................................... pursuant to application dated ............................. ~..~8 ................ 19..~3., and approved by the ~uilding Inspector Fee $.~,,.l~)..~,h~k p~,td Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No....~....~....O...~. ......... Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c ............................ ........... ................................. APPLICATION FOR BUILDING PERMIT Date ......................... , ...... INSTRUCTIONS o. This application most 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 o detailed description of layout of properly must be drown 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 o Building Permit to the applicant. Such perreit shall be kept on the premises ovoiloNe 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 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 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 all applicable laws, ordinances and regulations. /," ~. . /~ ~/ -'~y:.......~.9~ ..... L~:~....L,_ .~...~.~..e:.:.,~.: ....................................... (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. Nome of owner of premises ......... ~,..~.~:¢r.~.'.~.' .~,.......~...~"'r'a.~..~.>:~<~...~.-z~,,<.. .......................................................................... If applicant is o corporate, signature of duly authorized officer. (Name and title of corporate officer) Loc.arian of land on wh ch,proposed work w be done Mop No ............ Lot No: ............... Street and Number .... ~":~:~';~'%""~'~'?'~"~' ................... Municipality~'~'~'~>~' .~..~...,;.Z.:~..,...~.~.~...~...~ ......................... i..::: State existing use and occupancy of premises and intended use and occupancy of proposed construction: Exist ng use and occupancy ........... ¢.~,,~.'...~..~..~.:..):C~/.. .................................................................................... a. /' ,~/' , .... b. Intended use and occupancy .......... c~..~)/~..~:~.~ ................................................................................................ 3. Nature of work (check which applicable): New Building .................. Addition ...~ ...... Alteration .................. Repair .................... Removal .................. Demolition .................... Other Work (Describe) ........................ 4. Estimated Cost ................................. .G~..,,,~t~f~ .............. 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 ................................ ' / .......................... Depth ..~.~ ................... 7. Dimensions of existing structures, if any' Front ....... ~.~ .......... Rear ¢ ~ / ' / Height ..... ~..(. ............ Number of Stories ........ Z.~ ................................................................................ ' ........... 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 .......... ~ .................... 9. Size of lot: Front ............... ~.~ .......... Rear ............................ Depth ..... ~ ............................... ]0. Date of Purchase ........................................................Name of Former Owner ........................................................ 11. Zone or use district in which premises are situated ............... ~.,2~-*'~r~ .... .%- ~2. Does proposed construction violate any zoning law, ordinanc~or regulatio~P ........... ~ ~ 13. Name of Owner of premises~¢Z~.~,~.....Add re ss~ ~,~.... Phone ~ ., Name of ~ ~ . ,~ ~- ~ ~, ¢~ .. Name of ArChcontracteCt'~'~'~'. ~*..~~ ............................. .......... Address ~..~.~t.~Address ........................., . Phoneto ~ , . ~ Phone N~',~.~M~ ........ ~ ........... P~OT DIAGRAM kocote clearly ond distinctly o11 buildings, whethor existino or proposeQ ond indicote ~11 set-b~ck d~mensions from property lines. Give street ond block numbers or description occordino to deed~ ~nd show street homes ~nd indicoto whethor interior or corner lot. ¢~',¢o/¢- 6 STATE OF NEW YORK, ) c c COUNTY OF .......................... ;3 .... ........... (~¢-)X~,."~..~...~..~'~/,Z.~4~:¢:T....~ ...................................... being duly sworn, deposes and says that he is the applicant (Name of individual signing application) (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performed in the r~r~.e~¢~t~ forth in the application filed therewith. Sworn to befoze me th s ,~,c s/:de of Now York ........... ? :;.;,X Notary Public, ...~..'..4:~,¢:~...'.~.. LorJnfy (Signature of applicant)