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Home My WebLink About2921-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N.Y. CERTIFICATE OF OCCUPANCY No..Z'..a3~tl ............ Date ~l'Ove.~er 26 19 6~' THIS CERTIFIES that the building located at ~/..~ J~.D,~..~.~ .e....~.O.~...~. ...... Street Map No ...... ~ ............ Block No. X~ Lot No. ~r, C~C~hOI]~1,e conforms substantially to the Application for Building PeYmit heretofore (iled in this office dated ............................... ~'o.v.eml~,~......~ ......... , 19..~.~'... pursuant to which Building Permit No....~?.~..~...~ dated ........................................................ , ] 9.. , was issued, and conforms to oll of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ......... P~ iv. ate...one., f. ami~.., dwel lin~ ....................................................................................... The certificate is issued to J~(~ELe~ ~$~)?,1~L~.1~.~..~. ....... ~.~. .................... (owner, lessee or tena,nt) of the aforesaid building. Building Inspector FORM NO. 2 TOWN 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) N? 2921 Z Date ............................ Ro~e~i~l~ ....... ~..., 19..6.~. Permission is hereby granted to: Robt...T.t~th.l.~.l.....A/G..~dne~,..~u~g~tgnon .......... C-teho~ue ............................................... to ...~ .1~1...a~..a~d ~.t ~,on...orr..at~.. ~x i's t~_Zlg. 'd~e 'I'T :Lr~ ....................................................... at premises located ot ..... L~; .................... N~ss&~I...~ ................................................................. ........................... l~&ne..t~ee..Rea~ ~ .......... ~tehogue ................................................................... pursuant to application dated ................................ ~, .......... ~: .......... 19~'..., and approved by the Building Inspector Fee $.-.~.00 ........... · .l-~z/. ............................................. ;;t ...................... Building Inspector ~ FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined .............................., 19........ Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c_,j.~....::,,,.~.:.c.i'~..-:~.~.... ..................... -- (Building Inspector) APPLICATION FOR BUILDING PERMIT 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 deCailed description of layout of property must be drawn on the diagram which is part of thb 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 a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of o Building Permit pursuant to lhe 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 olgplicant agrees to comply with all applicable laws, ordinances, building code .and regulations. (Signature of applicant, or nome, if o corporation) ~ddress of p,ie y State whether applicant is owner, lessee, agent, architect, engi'neer, general contractor, electrician, plumber or builder. Name of owner of premises :.. .~ ..... tf applicant is a corporate, signature of duly authorized officer~ (Name and title of corporate officer) 1. Location of I~nd on which proposed work will be done. ,Mop ~1o.: ........................................ Lot No.: ............ Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: b. Intended use and occupancy .................................... · ............................................................. : ............................... 3. Nature of work (check which applicable): New Building .................. Addition ..~ ..... Alteration Repgir .............. ~,,;,Removal .................. Demolition ........... ~¢~,,Other Work (Describe) (to be paid on filing this application) 5. If d elling, 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 ..... ~..f ........... Rear ...,,~......,~....t'. .................. Depth Dim~ensions of same structure with alterations or additions: Front ..... ~ ....................... Rear Depth' ...... ~..~..f. ................ Height ...../~...../. ............. Number of Stories ....... ../. ...................... 8. Dimlensions,,~of/entire new construction: Front ...... .d/'/....i ..................... Rear ....././...~.. ............... Depth .....~.... .... Height ...~.. ............. Numb,er of Stories ............ ./.. 9. S~ze of lot: Front ...~.; ..~... ............ ~,. Rear ....... .( ........................... p h ............. .; ................. , 10. Dat~ of Purchase ....... ./...~..~....~... ............................... Name of Former Owne~..~..~..Cd~,/~...O...~.......~...~.~.. 11. Zon~e or use district in· which premises a, re situated .....:..-~.:.'T~...T. ................... ~.~.1. ~ t I 12. Doe~ proposed cor~sti'uction ~Ib.lcite any zoning law, ordinance or regulation? Name of Architect ...................................................... Address ............................................ Phone No. PLOT DIAGRAM Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate ail set-back dimensions fr property Ii'nas. Give street and block number or description according to deed, and show street names and indic whether interior or corner lot. STATE OF~ NEW' YORK, COUNTY IOF ................................ (Signature of applicant) .. i'./..;.....~.~.~ ..... ~:..~.. .................................... being duly sworn, deposes and says that he is the appiic, '(Name of individual signing application) abow! named. He is the ..... i ........ ..~.~,dL .~....~.-.~.~.~.~..(?../~.~'~ .......................................................................................... 1 .... . . (.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 applic~ation; that all statements contained in this application are true to the best of his knowledge and belief; ' that the work will be performed in the manner set forth in the application filed therewith. Sworn to defore me this ......... ....... day o,f ........... ,