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Home My WebLink About2333-zFOI~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~/..~..~.~J.'te...~,. ......................................... Street Mop No ..... ~ .......... Block No ......~ ......... Lot No. XX:[ ....... ~ti.~t~k~...[4,.~, ................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ....................................... ~%,~r~k....~.0......, 19..b...~'. pursuant to which Building Permit No. ~,,~,'~....Z... dated ............................. ~.v~a~.c~h....3.0....., 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 ........ ...~.~.~.~¢~..er~e...~+~.~.~..,~,.],~,,~t~ .............................................................................................. The certificate is issued to ....k(~he.~,.*.~...[:~.~..,~.~e.~. .......................... .0.~.~,z.; ...................................... (owner, lessee or tenat~t) of the aforesaid building. Building InspectoI FORM NO. ~ TOWN OF ~$oUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE $OUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MuST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2333 z Permission is hereby granted to: I~ol~e~.t.. &..~.e.t~a .. J~n~e ....... ,... ....... .., ............. ...... ..A~attILt~.....~ ...................................... ,... ot premises located at ...,..]~..t.~.~e.~....t ................. ~ ...... ~ ............... t ................................ ,....,.,. ..... pursuant to appliccition dated .....~ ............... i .......... .'.~.~ ....... ~.0..., 19..~., c~d approved by the Building Inspector Budding Inspector F~Ri~ NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ........................................ , 19 ........ Permit No. Disapproved a/c 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 adioining premises or public streets or areas, and giving o 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 o 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 o Certificate of Occupancy shall hove 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 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 lows, ordinances~~.~building code a~d/~ations./~. (Signature of opplicaj~, or nome, if o corporation) (Address of applicant) State wh~)~r applicant is owner, lessee, ogenll architect, engineer, general contractor, electrician, plumber or builder. (Nome and title of corporate officer) Location of land on which proposed work will be done. Mop No: ............................................ Lot No: .................... Street and Number .~.....~...~..,...~~ .............................................................. State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy ~ b. Intended use and occupancy .......~...~....;;T.....~.~.~.~7.,..~/,~.~.~,,._,z? ,--~~ 3. Nature of work (check which applicable): New Building ..' ................ Addition ..~.... Alteration ................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) .................................... 4, Estimated Cost ..... ..~/~...~.....~...~,...~.'~. ......................... 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 .............................. 7. Dimensions of existing structures, if any: Front ....~..?.~,~.../.. Rear ..... ~.x~,~./,. Depth ,,~..~....~. ........... I-leight.._........................ac/! - Number of Stories ......... /.. ................................................................................ . . . . . ........... Dimensions of same structure with alterations or aad.t ons Front ..... ~.....~..~.../.... Rear ......~...~,~..../. Depth .......... ~. ................. Height ........ ~.. .................. Number of Stories ........................................ 8, Dimensions of entire new construction: Front .....c~....~...~ .............. Rear ...... .,.'~.,..,,'~.,/ ......... Depth ..~.~ / Height ......... .~... .............. Number of Stories ...../.. ..................... 9. Size of lot: Front /..~. ~'~ ¢ / ,/~-c~ / ........................... Rear ....... /..~L .~.. .......... Depth ................................ I0. Date of Purchase ~../~."~¢~.L..Z'..~..~'...~.. ....................... Name of Former Owner ...................................................... 11. Zone~ or use district in which premises are situated ............................................................................................... 12. Does'proposed construction,v4e[ate any zonir/~ law, ordinance or, regu~olion? ..... ~,,,.~,, ................................... ]3. Name of Owner of premise~..~.~~Address .~,~...,~.,,,/~..~---~Phone No..~...~..~.T.~ Name of Architect "~'~,~'i'"-~ ...................................//-/ Address.._: ...................................... Phone No .................. Name of Contractor :.~'..w~c~......,~,...../~'~,,~Z ....... Address~,,....,~.,~.~; Phone No. 4~z~..'Z.':~.': PLOT DIAGRAM Locate;-clearly and distinctly all buildings, whether existing Or proposed, and indicate all set-back dimensions fro property lines. Give street and block numbers or description according to deed, and show street names and indica whether interior or corner lot. .pr ' STATE OFfNEW ,.~fOR~,~ ~ // / S S COUN~ OF ~~~...~ ' ' ............... ~..~..~,,.~ ..................... being duly sworn, deposes and soys that ~e is the applicc ~ame of indiv~ual~gnin~ appli~tion) above n~m.ed ~He is the ..................................................................................................................................................... (Contractor, agent, corporate officer, etc.) of said owOer or owners, and is duly authorized to perform or hove performed the said work and to make and ~ th s appJicction; that oil statements contained in this application ore true to the best of his knowledge and bell and that the work wJl[ be performed in the manner set forth in the application filed therewith. Sworn to b'efore me th s -- ..... ......... .................. ._ , :; ................ Notary Puklic, ./~~~unty ) (Signore of operant)