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Home My WebLink About2535-zNO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY NoZ..~'I ~.~ ............... Date ............................. ~ ....... 1~. ........ , 19...~.~.. THIS CERTIFIES that the building located at . jj/.j~..H~.~me.'J...A~.~ .................................. Street Map No .... ~ .......... Block No. ~ ............ Lot NCF..I~ ....... J~Ol~t,~-"t~ ..... ~..~'~, ..................... conforms substanhally to the Application for Budding Permit heretofore flied in th~s office dated ..................................... Q~::Jb~.... 2._., 19.(J~... pursuant to which Building Perm,t No ~,~3.~'..~..... dated ......................................... 0.~.$.,...~, 1~. ..... was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which th,s cert,f,cate is ,ssued ,s ........ ...... ......................................................................................... The certificate is issued to .... ~Tll~A/I...~...~t~I~I[D, ........................ ~ ................................... (owner, lessee or tenant) of the aforesaid building. Building 'ln~pec~f ....................... FORM 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) N? 2535 z Date .............................. J~t~13it~ ....... 2..., 19.....6~ Permission is hereby granted to: ct premises located ct ....... ~.J~....JJljaill~l..&~re ....................................................[ ........................... .............................................. ~onthoZd~ ..... ~[.:~. ...................................................... ~ ........................ pursuant to application dated .................................. 0tir. totD{l~.....~'~.., i9...0~, and approved by the Building Inspector -- Building Inspecto? FO~ ~0. 1 T~WN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........ ~..~ ..... 19 .~....~. ,, ,, Approved ........................................ , 19 ........ Permit No ................................ .... (Building I nspecto/0 APPLICATION FOR BUILDING PERMIT Dote .... ........ ..................... INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Buddin Inspector. b. Plot plan showing location of lot and of buildings on premises, relat,onship to adjoining premises or public streets c areas, and giwng a detailed description of layout of propertymust be drawn on the diagram which is part of th~s applicatiot c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Budding Inspector will issue a Building Permit to the applicant. Suc 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 a Certificate of Occupan¢ shall have been granted by the Building Inspector APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to tF Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances Regulations, for the construction of buffdings, additions or alterohons, or for removal or demolition, as herein describec The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations. ........ ...J. ....... ............................................ (Signature of applicant, or name, if a corporation) -- / State whether apphcant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or build¢ Name of owner of premises ..... .~.~....~..~./..~..~.. ...... ..~..'...../~.....~....~....~..~../.....~... ............................................................................ If applicant ~s ~ corporate, signature of duly ~uthonzed officer. (N~me ~nd title of corporate officer) ~. Locetion of l~nd on which proposed work will be done. Mop No' . ...........................................Lot No: ................ Street and Number ~~ ~~ , ~~ Municipality 2. State ex~stlng use and occupancy of premises and intended use and ~cupancy of proposed construction: a. Existing use and ~cupancy ............ ~.(f.~.~ ..... ~.~2K.~.f.~ ................................................................ 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 ..... ..~.,.../...~..f.?. ....................................... Fee ....................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... 6/~,..T2;..~.....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 .......................... 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 ............. ~. ............. Rear ....... J..[ ............... Depth ......................... Height ............................ Number of Stories ....... ~-~ ......... 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10. Date of Purchase ......... /..~. ............................... Name of Former Owner ...~.-'~.:..?..~.,~...c;..;~..~.~ ...................... 11. Zone or use district in which premises are situated .................. ~.....~..~..r.~...Z..: ................................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? ................. ./~...,.0. ......................... ~.-Z...Z .............. ..................... 13. Name of Owner of premises ,/ /. ,,~A~-~' /z,/ A4rlrnce .... ~,,~,:,.-...~../~,,~,..~,.f~, .................. P~hone 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 frc property ~ines. Give street and block numbers or description according to deed, and show street names and indict- whether interior or corner lot. STATE OF NL~W ,~R.K./~, /~' ~ c S COUN~ OF ~~ ~' ' ~ .......~~~~igni~, .... ........ being duly sworn~ deposes and says that he is the appli, above ~med. He is the .............. ~ ........................................................................................................ (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 thru application; that all statements contained in this application are true to the best of his knowledge and bc and that the work will be performed in the manner set forth in the application filed therewith. Sworn t~re me this ,~~~ /' ~ ..- ...... / rL , .................. .............. Nota~ Public, .~~~u~ ~~/ (Sianaur ~~ (Signatu e of ap~cant)