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Home My WebLink About3090-zFOEM ~0. 4 ?OWl~ OF SOUTHOLD BUILDING DEPARTMENT 'I'OWi~ CLERK'S OFFICE SOUTI-IOLD, 1~. Y, CERTIFICATE: OF OBI~UPANCY No..Z..2~.~ .... Date .................. ~une.. 29 .....19.6(~. THIS CERTIFIES that the building locaIed at . ~.0t2,~d. ~.~h.~)~t~.~..' ...... Street conforms substantially Go the Applicati,on for Building Permit heretof~o~e filed in this office dated ............... ~t~ .... 16 19,. 6~p~rsuant to which Building Permit No...3.0.~.0.. ~ dated .............. ~/~.~..,'1~., 19..6~, was issued, and conforms to all of the require- ments ,of the .applicable provisions of the law. The .occupancy for ~vhich this certificate is issued is . .. P.~ivate..ore. fami;gy · ~el~in§ ........................................ The certificate is issued to ...~41~,~., .F.~o~/lO~..~o~tl~Ldo.a ........ 0ASA~ ............. . (owner, lessee or tenant) of the afore.said building. ~Suffolk County Department of Health Approval ....... N,. 1~ ........................... Building Inspector \ FOI~M NO. 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE $OUTHOi. D~ H, Y. BUILDING PERMIT N9 Permission is hereby granted to: (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) pursuant to application dated .............................. -Ma~ ....... ~6' ........... 19~6...., and approved by the Building Inspector Fee $~ ~ .~0 ............... FOEM NO. I TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. Approved ......................... ~.~ ............ , ........ Permit No. ....................... ..-~...~.~-::~. .................................. ,, -- (Building Inspectq/r) APPLICATION FOR BUILDING PEI~MIT INSTRUCTIONS a. This application re?st be completely filled in by typewriter or in ink and submitted in dupJicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premises or public streets ar 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 b~ occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy sha~ have been granted by the Bui[ding 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) (Address of applicant) State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. .............................. C. ontrae£or ........................................................................................................ Name of owner of premises ...~.S~...F].O~.~e...,.~.~}~,~ ...................................................................................... If applicant is a corporate, signature of duly authorized officer. (Name and title of corporate officer) 1. Location of Jand on which proposed work wil~ be done..Map No.: ...... ~&~t,..~:~l.~...~.. Lot No.: .J.Z...~.."~.'~ ..... Street and Number ....~ol~t~'"~o}t"D~"~.'~e'"'" ........... sv~$'l:'~t~ ................................................................. Municipality 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy ............ ¢l, lt/e~3..$~ ................................................................................................... b. Intended use and occupancy ............. ~/~te..~.t,,~..&d.d..:~¢~.o~ ........................................................................ 4. 5. 6. 10. 11. 12. 13. L.ocat~ property Ii whether in~ NatUre of work (check which applicable): New Building .................. Addition ...... ~ .... Alteration ............... Rep4ir ................... Removal .................. Demolition ..................Other Work (Describe) ..................................... Estimated'j Cost ..... .~.~.~ .......................................... Fee .........~.' .......................................................................... (to be paid on filing this application) If d~vel[ing, number of dwelling units .......... .~D.~ .......... Number of dwelling units on each floor ........................ if gal/rage, number of cars ................................................................................................................................ : ......... If b'usiness,[ com. merciol or mixed occupancy, specify nature and extent of each type of use ........................ D~m~nsions of existing structures, Jf any; Front ............................ Rear ................................Depth .................... Height ........................ Number of Stories Dimensions of same structure with alterations or additions: Front .................................... Rear ....................... Depth ................................ Height ............................ Number of Stories ................................ Dimbnsions of entire new construction: Front ............ ~ .................. Rear ...... ~,0 ................. Depth ...~"~..i ........ Height .................... Number of Stories ...... .t~J).~. ................................................................................................. Sizejof lot: Front ........ 'J/00. ............ Rear ..............'l-gO. .............. Depth ,..,~.~O..~,,Z ............. Date/ of Purchase ........................................................ Name of Former Owner .................................................... Zonp or use district in which premises are situated .................. .~,.~....d~tt.~ ............................................................ Doe~ proposed construction violate any zoning Jaw, ordinance or regulation? ............ ~0, ...................................... Nar ~e of Architect ...................................................... Address ............................................ Phone No ................. Nar ~e of Contractor .................................................... Address ............................................ Phone No ................. PLOT DIAGRAM ~ clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions ~es. JGive street and block number or description according to deed, and show street names andl indicate erio~..f)r corner lot. STATE OF." NEV,2. YORK. COUNTY iOF :.~....'~..~Q,~ .............. W. dwsa. d Al~itz ................................................................................................ being duly sworn, deposes and says that he is the applic, Name of individual signing application) Contractor abow! na~ed. He is the .......................................................................................................................................... (Contractor, agent, corporate officer, eta.) of said o~ner or owners,' and is duly authorized to perform or have performed the said work and to make and this applic arian; that all statements contained in this application are true to the best of his knowledge and belief; that the w )rk will be performed in the manner set forth in the applicotic therewith. Sworn to b .~fore me this 6 day of ......................... ~'., ..........., 19..~.~.. Puklic'~' .... ~.~. ¢..c.~c ..~.~. ~..~,....~. ,...j.(.~.~6,, .~..,~..... ~2 County (Signature of apl: Notary