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Home My WebLink About3215-zFOR,M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the bu,ldmg located at ..WU~. ~,.t~ell~..J~Ve .............................. Street Map No ...... ~ ..... Block No ,,.....:11~:~. ..........Lot No ...... ~ ................ ..~.~.~...~:~....o.¢j'~.e.,.~.....'~...... conforms substantially to the Apphcot~on for Building Permit heretofore filed in this office dated ..... ~..~.~.~.~..~.....~..~. ................... , 19.~.~... pursuant to wh,ch Budding Permit No~.~...~.~.~.. ..... dated ..~J~t,~e~ll]~'...~2. .................. , 19.66 , was issued, and conforms to all of the reqwrements of the apphcabie provisions of the law The occupancy for which this certificate is issued is ........ .......... .V~r. ag.e..~m~, m.tox:a~e., hu:L3,din~ ......................................................................... The certificate is tssued to ...... ~.~JL~..~li;~p.~i.i~..~y .~.O ........................................................... (owner, lessee or tenant) of the aforesmd building ~uildlng ~[)~pector ' FORM NO. 2 TOWN OF $OUTHOLD 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°. 32i5 Z Date .......................... ~1:t ....... ~. ........... , 19.~.~.. Permission is hereby granted to: ~t~,~..~e~c...~..Co...~~p~ ..... ....... ~s~..~ek...Ave ....................................... to. ~]_d.. 2..ear...g~e.. om..e~t~.. ~~l~ ........................................................ at premises located at ...~.....~2~..~e~..~ve ........................................................................ ................................................. .~~.~..~Z~ .......................................................................... pursuant to application doted .............................. ~ep~. ....... ~ .........1~...., and approved by the Building Inspector Fee $....~'.e.(~ ........... Building Inspect7 FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Examined ........................................ , 19 ........ Approved ................................... :...., 19 ........ Permit No ............................. Disapproved a/c .............................................................................................. Application No ................ ' ........... ^PPUCAT,ON UlLDING PEm IT Date ..... ..... ...................... , INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Bu~ldm Inspector. b Plot plan showing location of lot and of buddings on premises, relationship to adjoining premises or public streets, areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this applicatio, c. The work covered by this opphcotion may not be commenced before ~ssu~nce of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Build,rig Permit to the apphcant. Such perm 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 Occupant 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 tk Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other apphcable Laws, Ordinances Regulations, for the construction of buildings, additions or alterations, or for removal or demohtion, as herein describec The apphcant agrees to comply with all applicable laws, ordinances, building code and regulations><~ ~ (Signature of applicant, or name, jfa corporation) .5 (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or budde 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 M~p No · . ....................................... Lot No.: ...................... Street and Number J~"~S/-- 6~.4~ 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 .................. Ad&tion .................. Alteration ..... Repair .................. Removal .................. Demohtian .................. Other Work (Describe) ~-~....~...~5~/-&..~.4~- 4 Estimated Cost ........ . .'~..i.....c~.. ?..?..:.. ~. ....................... Fee ............................................................................... (to be pa~d on filing th~s apphcot,on) 5. If dwelling, number of dwelling units ........................... Number of dwelling units on each floor .......................... If garage, number of cars .........~ ....................................................................................................................... 6. If bus~ness, commercial or m~xed occupancy, specify nature and extent of each type of use ......................... 7. Dimensions of existing structures, if any: Front ..................... Rear ................................ Depth ................. Height ........ ~...( .......... Number of Stories ...... ..~....~I'..~~. ........................................................................................ D,mensions of same structure with alterations or odd~t,ons Front ............. ..~..Z../. ............. Rear ....... ..~...?...¢. ...... Depth ........... :..~....~.. ............ Height ........ ~.. ................ Number of Stories ............................. 8 D,mensions of ent,re new construction. Front ......... ..~....~.. ................... Rear .......... ~....?.. ......... Depth ......~......~. ...... Height ...... ~..../. ...... Number of Stories ........ .~....."/~..~.~.. ......................................................................... 9 S~ze of lot: Front ............................ Rear ................................. Depth ................................ 10 Dote of Purchase ...,~...~...~...:..../..~..~..../..~...~..~...~. ............. Name of Former Owner ....._~..~....,~...x~....,~.~....~.~...~ff....~...~.~.....~'.~...~..,. 11. Zone or use &strict in which premises are situated ...... ..~.. .................................................................................. 12. Does proposed construction wolate any zonjng law, ordinance or regulation~ ......................................................... 13 Name of Owner of premises ..~...~.~.. ..... C.~. ............... Address ..~..'....~...~..~.[C./..c....~.....~....~..L..~..~ Phone No~...~......~.Z'.~..~..; Name of Architect .................. ..r~'....~...x~..~.~. ............. Address ............................................ Phone No .............. Name of Contractor .................../~....~.....x~...~q. ................. Address ............................................ Phone No ................ PLOT DIAGRAM Locate clearly and distinctly all buildings, whether ex~sting or proposed, and indicate all set-back dimensions fror property hnes. Give street and block number or description according to deed, and show street names and indicat whether interior or corner lot. STATE OF NEW YORK, 1. c c COUNTY OF .. ..................... ....~,-~.~'~"~ ...... ~ ......................................................................... being -- ~ (Name of individual s~gning application) duly sworn, deposes and says that he is the apphcar (Contractor, agent, corporate officer, etc ) of sa~d owner or owners, and is duly authorized to perform or have performed the said work and to make and fH this application, that all statements contained in th~s apphcat~on are true to the best of his knowledge and behef; an that the work will be performed in the manner set forth m the apphcation filed therewith Sworn to before~ ~',. , ---,.~-.me this ..~ ~,~4~ 7 .~_~~ ............ .............. ...... . .................. ...... ~ ]41ly PIJBLICk'S.L~...~ N~;I: York .......... Notary Public, .~/~-~;.~.;~~ ..... County (Signature of applicant)