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Home My WebLink About2277-zFOlt~l NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at Ba~. Home Road~ Sotlthold Street Map No. [~g~..E~Eck No. ' ..... ' Lot No. conforms substantially to the Application for Building Permit heretofore filed in this office dated ........... J~..~ ................................. , 19..~.. pursuant to which Building Permit No. ..... dated ..~a~r~..2. ................................ , 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 ........ One f~ily ~elling The certificate is issued to ~OU~S Perk~nson (owner, lessee or tena,nt) of the aforesaid building. FOKH NO. ~ 8UILDIN~ DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIY (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) permission is hereby granted to: pursuant to"application dated ...................... ~/~t1~:...~ .............. 1~...., and approved by the Building Inspector Fee $..~'.,.~. ............ Building Inspector TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......~.~;.qT3.:....'.~.7. ......... , 19 Approved .................. !.! ..................., 19...'.....Permit No. 6'~C~ ? y ~'~' APPLICATION FOR BUILDING PERMIT 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 part for any purpose whatever until a Certificate of Occupancy shall have been granted 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 Southotd, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buildings, additions ar alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances and regulations. ..... ~l~.w~z.Ck.~.m~.o~l .............................................. (Signature of applicant, or name, if a corporation) Southold (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ........ [~Ot~J.S...~.e~kSJl,~OD, ........................................................................................................ 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: ........... ?..~..~.~...e.~...~..t¢. ......... Lot No: ...~ .......... Street and Number ...l~/.~.....]3a~..iJom~...R~ad~.....~.oLLtho.~.c~ .................................................... Municipality 2 State existing use and occupancy of premises and intended use and occupancy oF proposed construction: a. Existing use and occupancy ......... .d~.e'l]-'l[l~ ...................................................... '. ............................................... b. intended use and occupancy ........................... 9/~,. ~..~.~...O,d,d~.~.:l..O~ .............. 3~ NaCure of work (check which applicable): New Building .................. Addition ~ ..... Alteration ..;,~lr~ Re~air .................... Removal .................... Demolition .............. : ..... Other Work (Describe) 4. Estimated Cost ...~/tO~)0...~./,~I ................................... Fee ....~.,..0..0.... (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 7. Din~ensions of existing structures, if any: Front .......................... Rear .......................... Depth Height ............................ Number of Stories Dirhensions of same structure with alterations or additions: Front ................................ Rear De[6th ............................ Height ................................ Number of Stories ........................................ 8. Dimensions of entire new construction: Front ................................ Rear ............................ Depth Height ............................ Number of Stories .................................. 9. Size of lot: Front .......... .'1-0~9. ........... REar ........ 'l_0~9 ........... Depth ...... .30 ............................ 10. Date of Purchase ........................................................ Name of Former Owner ......... 11. Zone or use district in which premises are situated....l~l, ll.....~.et,]ff. ................................... 12. Does proposed construction violate any zoning law, ordinance or regulation? ............ 13. Name of Owner of premises ...L...~e.~[OI'~I~OII. .......... Address ....... I~.~O~I.~[. ................. Phone No. Name of Architect ...................................................... Address ............................................ Phone No. Name of Contractor ..~....O~Z'.&~il.l~h[ .................... Address ............ ~ol~t,~l,~'[d ............. 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 idterior or corner lot. L STA'I'E OF NEW YORK, ) COUNTY OF ...~.U~,~o.],k ........ ) S.S. ................. ',~[],a~Q~'.t~...(~Z'.&.'l;h~/Q~. ................................ being duly sworn, deposes and soys that he is the applic¢ (Name of individual signing application) above nar0ed. He is the ........... (].O~t;~l.e.~O~ .................................................................................................................. (Contractor, agent, corporate officer, etc.) of said ow, her or owners, and is duly authorized to perform or have performed the said work and to make and this c~ppli~ation; that a I statements c~Jlhdd ~d s app ication are true to the best of h s knowledge and bell and that the work w~ll be perforrr~ ~r~.~, ~rcsettyfortb ~n the apphcahon filed therewith. Sworn to before me this .................... ............ Notary Pu?ic, _~,.,-,~f,..~......' ~__~unty (Signature of a~plicant) 0 l J0B NO. 5.EET NO. DATE aEV..O. REVISIONS REV. BY APR. BY JOB NO. I F . oR~5, JOB NO. SHEET N, REVISIONS DATE DRAWN H-i4-~4. DRAWN BY CH£CKED BY ..J