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Home My WebLink About2645-zFORcM NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTh,4ENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY No ..... ~..~2fi3 ........ Dote ........... OC~fl:~e~...ll ................... , 196,5.. THIS CERTIFIES that the building located at~/~,..JiJO~t'.~h...RC~,~r..~l,/,t}l~ .............. Street Map No ..~ ......... Block No ...~[~)[ ......... Lot No ....... ~ .................................................... conforms substanhally to the Apphcahon for Butld~ng Permit heretofore filed in th~s office dated ............... ~.li~;~a:['.~...~,5 .......... , 19.65. pursuant to which Bulldmg Permit No2.~.~.5..~... dated ............ [Ii~t~:~7~:...2,.~ ........... , 19. ~.., was ~ssued, and conforms to all of the requirements of the applicable provis~ons of the law The occupancy for which th~s cerhficate is issued ~s ....... a~ld£tion to ~well£n.~. The cerhficote is issued to ..JOS~lm~..D,~OSkoSk~, ........................................................................ (owner, lessee or tenant) of the aforesaid building Building Inspector FOR~V~ 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? 2645 Z Permission is hereby granted to: ......... ~:...~.~..~...~ ......................................... ........... ..S...o...~....r...~..~..~....D... ............................... to ...~.~. ~.~...~.......A.....¥. ..... A..~..~.. ~..:~:: :....o....V......o.....~. ..... ~..~.....~...r:..~.~Z.!.~ .~....~.~.~..~ pursuant to application dated ......................... ~...~...~....~...~.. ......... 19....~..., and approved by the Building Inspector Fee $ ~¢~......~.....~../L ,~.~ NO. I File in duplicate Fee for addition - $5.00 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. APPLICATION FOR BUILDING PERMIT Dat, .......... ....... .................. 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 port for any purpose whatever until e 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Lows, Ordinances or Regulations, for the construction of buildings, additions or olteratior The applicant agrees to comply with oil applicable lows, ordinan( for removal or de~olition, as herein described. ilding code and ~gu~ations. 1, ] /2 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .................. ....................................... Name of owner of premises .... ~...~ .......... .~.../..~..( ....................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) Stre~ and Number ...~....~..~.~.~ ...... ~.~.~.~. ............ ~..~..~.~..~.~ ......................................... ~unicipeli~ 2. State existing use end occupancy of premises ~nd intended use end ~cupency of pr~osed construction: o. fixistin~ us~ ond ~cupnncy .... ~ .............. ~ ....................................................................... , ......... b ntended use and occupancy S~ ............... ~. ~ ~ 3. Nature of work (check which applicable): New Building .................. Addition ....,C~. ........ Alteration .................. Repair .................... Removal .................... Demolition .................... Other Work (Describe) ...................................... 4. Estimated Cost ..... .~.~x..~...~ ............................ 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 ...... ...~.....G. ........... Rear..........................~ (' Depth .....'~..'.~.. ................. Number of Stones ............................................................................................................... Height ............................ ' 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 C~vner ........................................................ 11. Zone Or use district in which premises are situated ......... ,~ ............... .~..../...~.../... ............ :/..~/.) ................................. 12. Does proposed construction violate any zoning law, ordinance or regulation? .......... ../...~....~.. ................................. 13. Name of Owner of premises~.~.....~.../~'...~.$'~ f2~J~°'~'<' ..................... Address .......~..~...~..~./)..0.~.(.~.. .............. Phone No ..................... 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 numbers or description according to deed, and show street names and indicate whether interior or corner lot. STATE OF NE~Y~K,~, ~. ) COUNTY OF (.,,~':~..IL.u..~..,~.. ......... ~ S.S. ~ ~ 0~ o · ....... ....... , ................................................................... bmng duly sworn, deposes and ~ays tfiat fie is tile applicant (Name of individual signing application) above ~med. He is the ................ ~ .................................................................................................................. (Contractor, agent, co,orate 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 application; that all statements contained in this application ar~ true to the best of his knowledge and belief; and that the work will be performed in the manner set forth in th~pplication filed ~rewith. Sworn to before me th~s ............... ..... .... , ....... .... ~oto~ Public, .~..~ud~~..~ou~