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Home My WebLink About2371-zFOi~i~ NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .N./~.....~'J,~Q~..~.~; ........................................ Street Map No....~ ......... Block No ..... ~ ........... Lot No.....~.~.~.......O...~..],..~.~.~...t.L...~?..Z..? .................... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................................ AprJ,.~....2~'...., 19.6)~.. pursuant to which Building Permit No.~,~ ..... doted ............................ Ap~,~.1..,..2~' ...... , 196~..., was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ...... ~.r :LV. a~ ~...o~e.. ~:~m~ ~;~.. ~.]~ .~Z-~.~ .......................................................................................... The certificate is issued to ..... ]~L,].],,'~.~...~r~,,rCh~3. ................... (}'~r~, .............................................. (owner, lessee or tena,nt) of the aforesaid building. FOI~M NO. ~ TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE K~:P'I~ ON THE PREMISES UNTIL FULL COMPLETtON OF THE WORK AUTHORIZED) N? 2371 Z Permission is hereby granted to: .............. .(~k~t~ ,..... ~.,. [,. .................... ,.., ......... to ,...~u~,;L&.,an,.add~Lt~on..on.. au., ~,C,t$~..c~e~,~L~lg ..................................................... at premises, located at ........ .[[~...J~.~ ................ t ........................................ [ .......................................... ........................................................ O~en~ y.....l~**.~ ............. ~ .................... : ........................................ .... ~[ ..................................................... ~.; ........................................................ ~ ............................... .. ....... 196.~.,.., cjnd approved by the pursu6nt to a~)plication dated ..................t ........ /l,]p~.~l....,~Jf. ............ Building Inspector Fee $...~.QO.;....~?. ...................... /~,';ii~iing !nspec Or '~": .... FOI~i~I NO. 1 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ......~.~....c~..~. ......... 19..~?...~ Approved ........................................ , 19 ........ Permit No ................................. Disapproved a/c ................ ......................................... (Building /[~spector) Application No...~....?..?../. ........... APPLICATION FOR BUILDING PERMIT Date ......~..~....~../..%........~..~. ........................ , 19.~.~.. ........... INSTRUCTIONS a. ,This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building [nspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoinir~g 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 pa rt 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 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 and regulations. r'. .................................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. 8.e . fi ......... Nome of owner of premises ...~../..~..Z...z'..Z.../.~.........~...:.....?..~./'...~:/...Z~.~..~..i ......................................................................................... 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: ............................................ Lot No: .................... Street and Number .....~.../...'~/....~.. ...... ..~.~....~.. ......................... ..~.....~.../...~./.~?. ............ ~L.~.. ................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............. ~..'k~./~..X...A.../..~..~c ......................................................................................... b. Intended use and occupancy ................................................................................................................................. 10. 12. 13. Nature of work (check which applicable): New Building .................. Addition .................. J Alteration Repair .................... Removal .................... Demolition .................... Other Work (Describe) ........................ Estimated Cost .........~.~ ....................................... Fee (to be paid on filing this application) If dwelling, number of dwelling units ............~ ............... Number of dwelling units on each floor ....~. If garage, number of cars If business, commercial or mixed occupancy, specify nature .and extent of each type of use Dimensions of existing structure,~ if any: Front ....... .~.~ .............. Rear ........ ..~.~. ........... Depth '~ Height ...... .~'..4;. ................ Number of Stories / Dimensions of same structure with altera~tions or additions: Front ............ .~..~..-. ............ Rear Depth ...... ~'...Z? ................. Height ...... /.~. ..................... Number of Stories ........./'. .............................. Dimensions of entire new construction: Front ...........3....~. ................ Rear ..I ........ ~ .............. Depth Height ............................ z'~ N~umber of Stories' ............. / ~ ..................... Size of lot: front ................................ Rear ....................................... Date of Purchase ..... ~./.~:..../..~.~.~ ........................... Name of Former Owner ...~.~..* ............. Zone or use district in which premises are situated. Does proposed construction violate any zoning law, ordinance or regulation? .... ~/...¢. ........... Name of Architect ...................................................... Address ................ P.,/...~..: ................... Phone No. PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions f property lines. Give street and block numbers or description according to deed, and show street names and indk hether interior or corner lot. . .~ ~, ~.~ . ' *~' ~ ........... t *~'-o I L 'F )m ~te STATE OF NEW YO~K, ) COUNTY. OF ..~.~.~..~...¢./...~. ........... ) S.S. ..... ................................................. be,ng du,y sworn, deposes a.d says that he is :he app" , (Name of individual signjn~ application) above named. 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 this application; that all statements contained in this qpplicotion are true to the best of his knowledge and bel and that the work will be performed in the manner set:.forth in the application filed therewith. Sworn to before me this ................................................... ........... ....................................... Pdblic ~F~ Z ~ ~OTARY PUBLIC, Notary ~ '~,~'.~']-~]"~v-"~'"~:'~:V~O'O"' ~o1~ Cmmty (Signature of applicant) ~ ~ ~' term P2xoiros March 30, 19~