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Home My WebLink About2853-zFOEM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SO.UTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at .~../S....J'~.~.~....~...O..~...~...&....I~.~..:~/~...~L~.....~..~..-.... Street Map No...~ ............. Block NO....~ ............ Lot No ...... ~ ~..O.~.O..1~.:...~:.~. .......... conforms substantially to the Application for Building Permit heretofore filed in this office dated ........................... .~...e.J~..~..e....l~...~...~....~. ............. , 19......~..'~pursuant to which Builc~ing Permit No. ~8,~.~ ~ dated ................. ~.~...t..e....l~..~.~.....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 ........ ........................... ~.u ~.~r~ ~... ~.t,.o~.~.~e....~..~.~..~ ~.o.g ............................................................. the certificate is issued to ......... .~...o..~...e.~..h...[,..i..~..],...~.~.~. ....................... (owner, lessee or teniant) of the aforesaid building. FOEM NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFIGE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) 2853 Z Permission is hereby granted to: g. oz.eph..&..l:~o~t,k~,....t;l~ah ..................... ....... .Oaklawa.,Av.e .............................................. ................. .a...o.~.~.TA~ .......................................... to~,u,,~!..a.....a,..e.~..~.e.~ b~:~l~ i~.~e s~d) ............ at, premises located at ....... ,~.,,~,',,,~.~,.,~,~.~,,,~,~.,~,,~,~ ................................................ ........................... .:....i ....................... ~.~.~.:~,~.....~.z. .................................................................... pursuant to applicofio~i dated ................................ .~.-~..~.....~ ........... 1~'..'.., and 'aPProved by the Building Inspector Fee $~ O.*.O~..., ......... Building Inspector ~ FORM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Application No. APPLICATION FOR BUILDING PERMIT Dote ...................... ...~...~,:....~......~ ............... , 19.~J,.-~..... 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 pub c streets or areas, and giving a detailed description of layout of property must be drawn on the diagram which is p~rt 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 ir~oection throughout the progress of the work. e. No building shall be occupied or used in whole or in port for any purpose whatever until o Certificate of Occupancy shell hove been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Perm t pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordim3nces or Regulations, for the construction of buildings, additions or alterations, or for removal or demolition, as herein described. The applicant cgrees to comply with oil applicable s, ord~3rm~s, buil~.~;~nd rag laws, ord' s, buildi je.~;~nd regulations. r name, if a corporation) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. ....................................................... If applicant is a corporate~ignature 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 ~--~../..~ ....~.~~ ~--...~...~..~.~/...~....~ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ...... ~ b. Intended use and occupancy .... ~ ~.~ ~. ~ .~,~ ~.~ ................ 3. Nature of work (check which applicable): New BUilding' .i'.~'. ........... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition ............. ,... Other Work (Describe) ........................................ 4. Estimated Cost . .~....~....e-~.....= .............................. i ......... Fee .../...~..~ ....... J ................................................................... (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 ....... ~...5..[ ............ Rear ....... .~....5-.... 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 ........................ Height ../..~...~/..~. .... Number of Stories ....~ ........................................................................................................ 9. Size of lot: Front ....... ./...~..~.~ ........... Rear .......... ~....~..~..~ ............... Depth ......... ~....-~..~. ............ 10. Date of Purchase ................ ./..~..~..?. ............................. Name of Former Owner/~.~.....~.~~... 11. Zone or use district in which premises are situated ........ ~.~...-T.~.~'~.,~. .......... (/~ ........................................................ 12. Does proposed construction ~_olote any zoning law, ordinance or~-~.. ................................................ .....~--~ .............. Phone No ............... ~ ~' 9".-~,.. 13. Name of Owner of premis~,w..~.~....~../..'~.~.C../K. ......... Address Name of Architect ......................................... ............. Address ............................................ Phone No ..................... Name of Contractor .................................................... Address ............................................ Phone No ..................... PLOT DIAGRAM Locate clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions from property lines. Give street and block number or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NEW YORK, )~ ¢ ¢ COU NTY~OF ................................ .~ ~'~' ............ ~.~ ............................................ being duly sworn, deposes and says that he is the applicant (~/(Name of individual signing 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 file this application; that all statements contained in this application are true to the best of his knowledge and belief; and that the work will be performe~d in the manner set forth in the applicatigr~F~led therewith:..._~ Sworn.to before me this // -- ~