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Home My WebLink About3055-zTOWN OF SOUTHOLD BUILDING DEPARTMENT 'I"OV~'I~ CLERK'S OFFICE SOUTHOLD, N, Y. CERTIFICATE DF' OCCUPANCY THIS CERTIFIES that the building located at .. iaaei.Ol~. DX°. & .l,4~.St;..D.~' .... Street Map No .... ~[ ..... Block No..~ ....... Lot No..~ .... ~~...~*~ ..... conforms substantially ~o the Application for Building Permit heretofore filed in this office dated ........... .~P~!$ .... ~, 19~. parsuant to which Building Permit No. 3Q~[. ~. dated ............. ~P~$~...~, 19.~, was issued, and conforms to all of the require- ments .of the .applicable provisinns of the law. The .occupancy ~or which this certificate is issued is . E~!:~ata .o~e. Sami3,y. dw~Zling .......................................... The certificate is issued ~o .~¢~.~..Q~P~g.~ ........... 01~0~.8 .............. (owner, lessee or tenant) of the aforesaid building. .Suffolk County Department of Health Approval ... ~Y...~.~. ~6...b~ .~.,..~i~a.. Building Inspector [ TOWN OF $OUT~OLD BUILDING DEPARTmEnT TO~N CLERK'S SOUTHOLD, N. Y. BUILDING P~:RMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) No. 3055 z Permission is hereby granted to: Reb~...Pa.~%....~'{t.... Az,.l~h~:~...l~ ~..~..:~' ............ ......... · t2.7.....]~eek..S~. ...................................... ....... ~s~. ~e~ ..Ct~7~...~f.o.Zr~ ................................ to ....~uit d.. ,n~.~,~...one .. ;[:~a~:~, l.;y.. ~w¢~1.1.in~ ................................................................................... at premises located at ....Le~.t,o~...D~...~.,hf.~.~..;D~ ............................................................................ ............................................ .$.Lo..u. ~ko..$.fb.,,, ..~.J.~ .................... : .............................................................. .................... t ............................... '~ ......................... V"U ............................................................................. pursuant to application da~'ed,.,,,..,..,,.,,... .......... :.,A~..~. ....... ~[p ..... . ]96&,.., and approved by the Building Inspector Fee $1.Q. ~]) ............ SUFFOLK COUNTY DE?AE~MENT OF HEALTH TO WHOM IT MAY CONCERN: The sewage disoosal facilities for a structure located at (Give d~tion) ' -- have been inspected by this Department and found to ~e satisfactory. District Engineer FOBM NO. 1 'r~OWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, No Y. ~xamined .................................... , 19 ........ Approved ........................................ , 19..~! .... Permit No. · Application No....~.....~....'~.-.-~. ........ Disapproved a/c ~ .......... ~ ................................ .............. ................................. APPLICATION FOR BUILDING PERMIT ~ Date ...................... ~-..~...~.../..L...../...~. ............. , 19...~..~. ..... 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 shah 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 buildings, additions or alterations, or for removal or demolition, as herein described. The applicant agrees to comply with all applicable laws, ordinances, building code and regulations. (Signature of applicant, or name, if a corporation) .............................. .......................... State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. .... ..................................................................................................................................................................... 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. Map No.: ........................................Lot No.: ..................... ~.. Street and Number ..... ~.'z../(.~?(.~..~.~.~~~..~..c..~.~...~..~.~../.?.~..~?~'~.~.~..?...~.~...~.~.(.). ..................................... ' 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 .~.~..F. ............... :.'.~:. ..................................................................................................... property li~es. Give street and block number whether interior or corner lot. 3. Nature of work (check which applicable): New Building ....... ..v- .... Addition .................. Alteration .................. Repair .................. Removal .................. Demolition .............. '..,. Other Work (Describe) ........................................ 4. Esti4ated Cost ............. ~.~..~.?'.I.(.! ................................ Fee ........ ?.../..b'.' ........................................................................... (to be paid on filing this application) , / 5. If dv~elling, number of dwelling units ............................ Number of dwelling units on each floor ............................ f ga!rage,' number of cars ......'~..~'...~.~..~..4.,~.(.-7. .................................................................................................................. 6. If bbsiness, commercial or mixed occupancy, specify nature and extent of each type of use ............................ 7. Dimensions of existing structures, if any: Front ............................ Rear ................................ Depth .................... h Haig. t ........................ Number of Stories ................................................................................................................. Dimensions of same structure with alterations or additions: Front .................................... Rear ............................ Deptlh ................................ Height ............................ Number of Stories ................................ 8. Dimtnsions of entire new construction: Front .............. Heig,'ht ...... ..~..i~. ....... Number of Stories ....~. ........................................................................................................... ~ ' .... /0'~, 3~~' ,, /~ 3,~ 9. ~ize[oT lOT: ~ront ........~ .................. ~ear ....... ¢. ............................ ~ .................................. 10 .... ~ ...................................... .~ ............................. ............................................................. 1 1. Zone or use district in which premises are situated 12. Doe~ proposed construction violate any zoning law ordinance or regulation? ...~..~ .................................................. ~. ~ ~ o~ ~ ~ .~..~.~c.~.....~ .~. ................... , ............ ~....~ ~. ~x.~....~.~ ..... ..................... ..................... Locat~ clearly and distinctly all buildings, whether existing or proposed, and indicate all sef-bac~ dimensions from or description according to deed, and show street names and indicate STATE OF NEW YORK, / ~c¢ COUNTY !OF ................................ ................. ~ ................................................. ; ..................... g duly deposes ond soys that he is the applicant i(Name of individual signing application) above na~ed. He is the .... ~.~.:~.~ ............................................................................................................................... (Contractor, agent, corporate officer, etc.) of said o~ner 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 w~rk will be performed in the manner set forth in the application filed therewith. Sworn to ~efore me this t ~m ~ t ~ /~ ~ ................ ~1,.¢7.~..~ ...... ~ ....................................... ; .............. Not~ry Pu~lic~.~ ..... ~:....~~.~,Cp~nty, (Signoture of ~pplicont) ~rTl~ ~xpires ~arch