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Home My WebLink About2327-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No .......... Z...2225 ..... Date ....... Oq.tobe~c i~L...., 19._.6._5. THIS CERTIFIES that the building located at ...]B~..%.~J. eT~...RQ~.,"~,...~,~..~..~.~.~...OJ~.... Street Map(J~'..c~.[a.~j~]~.... Block No .......... ~ ..... Lot No ........ ZZ~..~ ~Z~ ............................ conforms substantially to the Application for Buiiding Permit heretofore filed in this office dated .......................... ~¢~...2~ ..................... , 19..6~... pursuant to which Building Permit No. ~.~..~... dated ................ ~...25. ...................., 19...6~., 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 ........ AddStion t:o ~ell~n~ Y~e cerH~co~e ~s ~ssue~ ~o ..... ~.d..K~lO~ .................................................................................. (ow~e~, ~essee or FOl~I NO. ~ TOWH 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) Permission is :hereby granted to: Building Inspector Fee $..~eQO..: ......... · at prom?es located at .~.o~e...~..~8..~.,,.]:~....,~t[~;~lg~,,IL~...~..l~.~et~7 ...... ; ............... : ......... pur~isuonf' t6 application doted .............................. J~J~t~eJ~.....J~.., ...... 19.(~k~.,, ~i~d ap~r09ed .by'the ...: .................... .......... : .......... : ......... .~...;: .............. Building Inspector FORM NO. 1 TOWN OF SOUTHOLD BUILDI~4G DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. 'Y. Application No..,~...~-..~.....~.. .......... Approved ........................................ , 19 ........ Permit No ............................... Disapproved a/c ................................................. ~ ~,~....~... ................................. ................................. APPLICATION FOR BUILDING PER*MIT Dote ....................... ....... ............ ...... 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 propertymust 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 shc~l have been grcanted by the Building ~nspector. APPLICATION IS HEREBY MADE to the Building Department 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 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, building code and regulations. (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. Contractor owner of rem sos"~ '~'-']g't't'~' ..~...~./~J) ~ .~...~ [//,,J~. . ¢~'~. .~..:...~.....c~...Z ff'~'~'"~ · Nome of P .,~ ................. O .................. ........... ....................................... 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: ..G..~.~..~.:l:~,e.r..~..~.....~..~.~j~No:....................'1].8 Street and Number .~.~Y..~J,.~.¥/. ~.Y.e~ ..~.~J~.~ .0.~;J,f}~. . ............................ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ................ .¢l¥/.~t'l~,J.l:~g ............................................................................................... " W/ addition b. Intended use and occupancy ................................................................................................................................. 3. Nat?re of work (check which applicable): New Building .................. Addition ..... ~... Alteration ....~... Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................. (to be paid on filing this application) 5. If d~velling, number of dwelling units ........ Qll~,Jl ............. Number of dwelling units on each floor ........................ If garage, number of cars ........... .~.~l ..................................................................................................................... 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimbnsions 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 .......... .]-...~..'..~. ........ Depth .........~..0.~ ............ Height ............................ Number of Stories ...~I1~ ................. 9. Sizejof lot: Front ............................ Rear ............................ Depth ................................ 10. Datb of Purchase ........................................................ Name of Former Owner .................................................... 11.' Zonb or use districf in which premises are mtuated ........... JL...~;J.~.t~ .................................................................. 12. Doe~; proposed construction violate any zoning law, ordinance or regulaUon? ................ ,JJ'J) ............................ 13. Name of Owner of premises ...(~.,.~.~...~.t/J~ ............... Address ............................................ Phone No ................ Name of Architect ...................................................... Address ............................................ P'hone No ................ Name of Contractor ..... ~T~lll~-~..~o~er.s .................. Address ....... ]~.~,~.t,.....~'J,O~ .......... P,hone No ................ I PLOT DIAGRAM L.ocqt~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions fr~ property liges. Give street and black numbers or description eccording to deed, and show street names and indic, whether interior or corner lot. STATE OF:NEW YORK. ) -- COUNTY bF .~f.o].~. .............. / S.S. ........................... ~l~.~.~ ~'~ be ng duly sw~orn, deposes and says that he is the applice (Name of individual signing application) above na~ed. He is the ............... ~.Cll~t~&~.t~ ............................................................................................................. (Contractor, ogent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and · this application; that all statements contained in this application are true to the best of his knowledge and bell and that the work will be performed in. the manner set forth in the application filed therewith. Sworn to b~ef6re me this .,~