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Home My WebLink About3080-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOLD, N. Y. CERTIFICATE OF OCCUPANCY THIS CERTIFIES that the building located at ..~'ctz).se.'[;..,~ne ......................................... Street Map No...3:,~ ............... Block No ......... ~ ......... Lot No. ~ ....... (~6t~,,~0.O.[.~...~[,e.~..~ .................. conforms substontio(ly to the Application for Bui~din9 Permit heretofore flied in this office dated ............................................ ~,~....~ ....... , 19...~..~. pursuant to which Building Permit No..~.0...8..0.....~.. dated ........................... ~{~t~. ....... C~ ............ , 19..66.., was issued, and conforms to all of the requirements of the applicable provisions of the law. The occupancy for which this certificate is issued is ........ The certificate is issued to ....~.e.~...~:~t'~.e.:~. ...................... .0..t~/~.e..~ ............................................... (owner, lessee or tena,nt) of the aforesaid building. 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? 3080 z Permission is hereby granted to: .~.~.L k.~.....~.~....~..g ~.~..~..a.~L....~..~L...~.a....~ ~.~.~.z ~..~:.~.....~.~.~..k.k.t.~..~. at premises located at .~C..U....~.~'..e..,."J[. ....... .~....~...~....~*.--... ...................................................................... ........................ .......................................................................................... pursuant to application dated ........................... ..~,'.J..~..~..~ ........ ~ .... 19~.~.., and approved by the Building Inspector Fee $.~.. ................. Building Inspector FOKM NO. 1 TO~'N OF SOUTHOLD BUILDING DEPART/~ENT TO~A'N CLERK'S OFFICE SOUTHOLD, N. Y. Examined ....... ~'~ ...,~,.. ...... .~. ........ , 19..~...?.. Approved ........................................ , 19./. ..... Permit No. · Disapproved o/c ............. ~,.~.z'*~ ..................................................................... Application No......-~....C)......~..~.O... ........ (Building Inspector) APPLIC.S, TION FOR BUILDING PERMIT Dote ................. ......... ............ , ..... 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 shell have been granted by the Building Inspector. APPLICATION IS H.EREBY 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) G'~e n?ort (Address of applicant) State whether applicant is owner, lessee, agent, architect, engineer, general contractor, electrician, plumber or builder. Name of owner of premises ....~.e. xl.~,9.~.h...~, .~...e.-.~ ................................................................................................................. 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 ....S.o.n~e.t...L~,~e .................... G~.ee~0~)~..t ............................................................................. 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 ............. cS...z-~...(../~....~....... ~..~- i!.....'[...~.. ...... . ./.~.('.~..../~... D~.../...(..~. ~.. ~....~... ............... STATE OF COUNTY above nan of said ow this appli¢ that the w, Sworn to b Notary Pul 3. Nat re of work (check which applicable): New Buildihg .................. Addition ....~)~.. ,~...~.... Alteration ............. Repc~ir .................. Removal .................. Demolition .................. Other Work (Describe) ........................... ; ....... 4. Estin~ated Cost ~,~ (~. o O ~ Fee ~- . (to be paid on filing this application) 5. If al'veiling, number of dwelling units ...~....Number of dwelling units on each floor ............... ' ........ If ge rage, number of cars ................................................................................................................................ ........ 6. If b~siness, commercial or mixed occupancy, specify nature and extent of each type of use ............... I ........ 7. Dim ;nsions of existing structures, if any: Front ............................ Rear ................................ Depth .......... ; ........ Heicht Number of Stories Dimensions of same structure with alterations or addition~: 'Front ....................................Rear DE ~(h ................................ Height ............................ Number of Stories ................................ Hei¢ ht Number of Stories 9. Size of lot: Front ............................ Rear .................................... Depth ................................ 10. Dot of Purchase ...................................................... ~iN?.m.e.,~,, of Ff~rmer ~wner~__~_.~, .......................................... i ........ 11. Zon~ or use ¢istrict in which premises are situated ....~ ............ ~! .......................................................... 12. Doe~ proposed construct on v elate any ~oning aw, etd nonce or regulation? . L.~...?. 13. Note of Owner of premises~~' .Address ...~ ................ Phone No .......i ........ Name of Architect ........................................... ,. ......... Address ............................................ Phone No .......i ........ '. Nole of Contractor ...~.~.~~.. f. Address PLOT DIAGRAM Locot4 clearly and distinctly all buildings, whether existing or proposed, and indicate all set~back dimensibns f property lihes. Give stree~ and block number or description according to deed, and show street names and indic whether intjerior or corner lot. (Contractor, agent, corporate officer, etc.) and is duly authorized to perform or have performed the said work and to make land or owners, tion; that all statements contained in this application are true to the best of his knowledge and belief;' rk will be performed in the manner set forth in the application flied therewith. fore me this ,,--x ~. , Comm~smon Expires March 30, ~ ~ '/