The URL can be used to link to this page

Home My WebLink About3001-zFO~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 'J~/~,'""~9..~'~..'~d. .................................. Street Map No....~::~ ........... Block No ...... ~ .......... Lot No..~; ....... (~.$~t,..~.O~t.t,.~...~,.~., ............ conforms substantially to the Application for Building Permit heretofore filed in this office dated .................................... Jt~'~I'~'"'"P_.3" 19"6(~' pursuant to which Building Permit No. dated .................................. F~I}~'"'",~I~'", 19..-(~1~, was issued, and conforms to oil of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ ..... Bu~n~ ~...Bul.:~d~i,..o£~,~e:~ ...~.~.o~,~ge.~...~es.'C~u~..a~t...e.~c ................................... The certificate is issued to ....l~.eo~}ho]:.lo~..l~o~el~t[es....~ ................... O,~ner. .................... towner, lessee or tenant) of the aforesaid building. BUILDING P~R~IT (THIS PERMIT MUST BE KEPT ON THE PREMISES UN~*IL FULL COMPLETION OF THE WORK AUTHORIZED) N? 3001 Z Permission is hereby granted to: T ~n~... ~I~ ....~./.C.....'~.a o.~t~.!l.~...~lLo, p~r t i e ~ Zne ................. Or.L~.~.~....~.~,. .................................. Building Inspector Fee $.*.~**~ ~)O ........... at premises located at ....S./.~.....~o..~n..~e~d ............................................................................. ~ ....... :.. V ...................................... ~ ~e rzt .. ~o~.~ ~ ...~1, ._, .................................... : ....... 7.. ........ ~ ............ :,..~.,,..? pursuant to application dared ............................. FOI~M NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ,' 30ol Approved ........................................ , i0....~.'... Permit No ............................. / Application No ............................ Disapproved o/c ................................ . .~.._~.~., .,¢¢~....~.?. ............................. ..~_~ ............................... -::;7,~,. .................... ~L ............. "' c--~--- (Building Inspect~]~ ' 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 detailed description of layout of property must 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 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 the Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances or Regulations, for the construction of buiMings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code a,nd regulations. (Signor/~y*e of applicant, or name, if a corporation) .................. .................. ,... 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) 1. Location of land on which proposed work will be done..M,,ap No.: ........................................ Lot No.: ........................ Street and Number ...¢~:....~.....$.-T ........... ..~....-~..~.~...~ .......... ~..~ MunicipaJlty 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 .....~....~.¢ ............................................................................................................. 10. 11. 12. 13. Locate property lit whether i.nt~ STATF- OF COUNTY above nan of said ow this opplic that the w, Sworn to b .... Notary Pu ! Natur~ of work (check which applicable): New Buildifig. ................. Addition b/ Alteration Repai¢ ................ ~/Removal ..................Demolition .................. Other Work (Describe) ............................. i .......... , . I ~ Est~m,~ted Cost ..~.i ............................................. Fee .............................. (to be paid on filing this application) If dw;l[ing, number of dwelling units ............................ Number of dwelling units on each floor If gm :ge, number of cars .................................................................................................................................. i ........... If business, commercial or mixed occupancy, specify nature and extent of each type of use/ff~'"/Tz ~' Dime ~sions of existing structures, if any: Front ......?...~. ................. Rear ' ~ ~ ' Depth .....~..../. ........... Heigl't ........................ Number of Stories ........ ]. ............................................................................................ ! ........... Dimeltsions of same structure with alterations or additions: Front ...... ~.. ........................... Rear ................. . ........... Deptl' 3[ ~ Height / g t Number of Stories / Dime~ ~sions of entire new construction: Front , / / ~ Rear ...././...'. ................. Depth / 2- Height .../.~..t .......... Number of Stories ...... ( .............................................................................................................. Size f lot: Front ..~.ff./...~..2- . Rear ....... ..~:..,~...~...! ................ Depth ...... /.~..?...~...~. ........... Date of Purchase ........................................................ Name of Former Owner .~..~.' .................... l ........... Zone or use district in which premises are situated ~..~ ' : Does ~roposed construction violate any zoning law, ordinance or regulation? ...~..~.. ..................................L ........... Nam of Owner of premises .'~..~..~'~... ...'.~dress ..~..~~ Phone Nam of Architect ~,~,.,~- ~ .............. ,~,'~.~'~i ................ AddressAddress ............................................ ..~...-C..~ PhonePh°ne No.~..ff...~.?.!.?...2'.(-...Ne ......... ! ............ Nam of Contractor ...z..-.:#.....~....c..,.c..-...~....¥m:....,-:~>. ............. ..... ................. PLOT DIAGRAM clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensio.ps from es. Give street and block number or description according to deed, and show street names and indicate r'ior or corner lot. ' "L I EW ~YORK, 't ,- ,- : .......... .d.~...~......//~/~.,."~Z~.~.Z.~...~.. ...................................... being duly sworn, deposes and soys that he is the ~pplicont Name of individual signing application) ~ ed. He is the .......................................... .C...~...,J/..7'..~..~...c....~.~...~. ................................................................ ; ............. (Contractor, agent, corporate officer, etc.) j ~er or owners, and is duly authorized to perform or have performed the said work and to make land file ~tion; that all statements contained in this application are true to the best of his knowledge and belief; and ~rk will be performed in the manner set forth in the application filed therewith. ;fore me this