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Home My WebLink About2435-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 ,M~,r~..~o,~r..~a.~,~t:t~: ..................... Street Map No....~g~ ........... Block No .......~ ........ Lot No ............... ~ .............................................. conforms substantially to the Application for E~uilding Permit heretofore filed in this office dated ...................................... ~I1~'"2'2 ........... , 19..~.~.. pursuant to which Building Permit No. dated ............................ ~.U~rt~..~24 ........... , 19...64., 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 ........ ...................................... ~l~l~x,, addir, ion...to...o~e...~mi;ky....~l~L~.n.~ ........................ The certificate is issued to ........ fff$~la~..W¥~.e .............................................................................. (owner, lessee or teniant) of the aforesaid building. Building Inspector"""~ FOFu~FI NO. ~ TO~N OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, ~1. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 2435 z Date ............................ ; ............................... , 19 ........ Permission is hereby granted to: tO .......... - ..................... , ........................... ~ ...................... ; .................................... ~ .............................. ~ ...... at premises Jocated at ........; ................. .-....... ............................................................................................ pursuonf to application dated ......... .,.~ .................... ...... ~ .................... ;, 19 ...... ,., and approved by the Building inspector Fee $,,...: .................. Building inspector File in Duplics~te TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined Approved ......................................... 19 ........ Permit No.................................~ '~ ~' ~--- APPLICATION FOR BUILDING PEP~MIT Date 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 part for any purpose whatever until a Certificate of Occupancy shali 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 appJicant agrees to comply with all applicable laws, ordinances, building code and regulations. ~ ..... (Signature of applicant, or name, if a corpora¢ion) .......... State whether applicant is owner, lessee, age.gt, architect,~ngineer, general contractor, electrician, plumber or builder. Nome of ow er p ' . .......................................... ~.. ............................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of land on which propose.d.)/v, ork will be d~e,.~Map No: ~ ......... : ............................... Lot No: Street and Number ................. ../..~ ....... ~.: ........... ~~.. ...................................................... Municipality 9. State existing use end occupancy of premises and intended use and occupancy of proposed construction: 3. Nature of work (check which applicable): New I~uilding .................. Addition ,,~,,,, Alteration .................. Repair .................... Removal .................... Demo[ition ............. ~,.... 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 ..... .?....~. ............... Depth ......*~.~... ................ Height ............ Z.~.. ........ Number of Stories ...... ...~.. .................................................................................................... Dimensk~ns of same structure with alterations or additions: Front ........ ~ .................. Rear ...... ~ ................... Depth ......... .~....~.. ............. Height ........ .~..~.. ............... Number of Stories ....~.. ................................. 8. Dimensions of entire new construction: Front /~"~ Rear /~'-- Depth Height ......... .~.~.. ............. Number of Stories .... ..~.. .................... 9. Size of lot: Front ............................ Rear ............................ Depth ................................ 10, Date of Purchase ........................................................ Name of Former Owner ........................................................ 1 1. Zone or, use district in which premises are situated .................................................. ~. .......................................... 12. Does pr6posed construction vipla,te ~ny zonin~ law, ord nonce or repudiation? .... ./.~.: ........................ 13. Name of Owner of premises..~...~.,...~.....~......Address ......... ~:.:..~ ......... Phone Name of Architect ............ ~.~:~ ........ .~ .............. Address ......................... ~,;~..~ne No ..................... Nome of Contractor ....~.,~..~;~Address ....~-.~..~.~...~~..~..~,~l~none~ No. PLOT DIAGRAM Locate clearly and d stinctly a I buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. IGive street and block numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YOP~ ) - - COUNW oF; ....... '. .......................... ~....~~~ .................. being duly sworn, deposes and says that he is the applicant (Nome of individual signing~.~p~pJication) e the above framed. H s ................. ~ ............................................................................................................................ (Contractor, agent, corporate officer, etc.) of said owner or owners, and is du,ly authorized to perform or have performed the said work and to make and file this applicatioh; that all statements contained in this application are true to the Best of his knowledge and belief; and that the ~ork will be per~rmed in the manner set forth Jn the application ~led therewith. Sworn to before me this~ (~ ................. .... : ......... h ~i~ .......................... Notary Pub c,, ~ (S,gnature of apphcant) ' ~ -T